Abstract
Background
Time to hormonal control after definitive management of hyperthyroidism is unknown but may influence patient and physician decision making when choosing between treatment options. The hypothesis is that the euthyroid state is achieved faster after thyroidectomy than RAI ablation.
Methods
A retrospective review of all patients undergoing definitive therapy for hyperthyroidism was performed. Outcomes after thyroidectomy were compared to RAI.
Results
Over 3 years, 217 patients underwent definitive therapy for hyperthyroidism at a county hospital: 121 patients received RAI, and 96 patients underwent thyroidectomy. Age was equivalent (p = 0.72). More males underwent RAI (25% vs 15%, p = 0.05). Endocrinologists referred for both treatments equally (p = 0.82). Both treatments were offered after a minimum 1-year trial of medical management (p = 0.15). RAI patients mostly had Graves (93%), versus 73% of thyroidectomy patients (p < 0.001). Thyroidectomy patients more frequently had eye symptoms (35% vs 13%, p < 0.001), compressive symptoms (74% vs 15%, p < 0.001), or were pregnant/nursing (14% vs 0, p < 0.001). While the thyroidectomy patients had a documented discussion of all treatment modalities, 79% of RAI patients did not have a documented discussion regarding the option of surgical management (p < 0.001). Both treatment groups achieved an euthyroid state (71% vs 65%, p = 0.39). Thyroidectomy patients became euthyroid faster [3 months (2–7 months) versus 9 months (4–14 months); p < 0.001].
Conclusions
Thyroidectomy for hyperthyroidism renders a patient to an euthyroid state faster than RAI. This finding may be important for patients and clinicians considering definitive options for hyperthyroidism.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Brandt F, Almind D, Christensen K et al (2012) Excess mortality in hyperthyroidism: the influence of preexisting comorbidity and genetic confounding: a danish nationwide register-based cohort study of twins and singletons. J. Clin Endocrinol Metab 97:4123–4129
Conaglen HM, Tamatea JAU, Conaglen JV et al (2018) Treatment choice, satisfaction and quality of life in patients with Graves’ disease. Clin Endocrinol 88:977–984
Wu VT, Lorenzen AW, Beck AC et al (2017) Comparative analysis of radioactive iodine versus thyroidectomy for definitive treatment of Graves disease. Surgery 161:147–155
Zanocco K, Heller M, Elaraj D et al (2012) Is subtotal thyroidectomy a cost-effective treatment for Graves disease? A cost-effectiveness analysis of the medical and surgical treatment options. Surgery 152:164–172
Ross DS, Burch HB, Cooper DS et al (2016) 2016 American Thyroid association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 26:1343–1421
Adam MA, Thomas S, Youngwirth L et al (2017) Is there a minimum number of thyroidectomies a surgeon should perform to optimize patient outcomes? Ann Surg 265:402–407
Shinall MC Jr, Broome JT, Nookala R et al (2013) Total thyroidectomy for Graves’ disease: compliance with American Thyroid Association guidelines may not always be necessary. Surgery 154:1009–1015
Oltmann SC, Brekke AV, Schneider DF et al (2015) Preventing postoperative hypocalcemia in patients with Graves disease: a prospective study. Ann Surg Oncol 22:952–958
Langley RW, Burch HB (2003) Perioperative management of the thyrotoxic patient. Endocrinol Metab Clin North Am 32:519–534
Carter Y, Chen H, Sippel RS (2014) An intact parathyroid hormone-based protocol for the prevention and treatment of symptomatic hypocalcemia after thyroidectomy. J Surg Res 186:23–28
Elfenbein DM, Schaefer S, Shumway C et al (2016) Prospective intervention of a novel levothyroxine dosing protocol based on body mass index after thyroidectomy. J Am Coll Surg 222:83–88
Sundaresh V, Brito JP, Thapa P et al (2017) Comparative effectiveness of treatment choices for graves’ hyperthyroidism: a historical cohort study. Thyroid 27:497–505
Cohen RZ, Felner EI, Heiss KF et al (2016) Outcomes analysis of radioactive iodine and total thyroidectomy for pediatric Graves’ disease. J Pediatr Endocrinol Metab JPEM 29:319–325
Sheehan MT, Doi SA (2016) Transient hypothyroidism after radioiodine for graves’ disease: challenges in interpreting thyroid function tests. Clin Med Res 14:40–45
Abraham-Nordling M, Torring O, Hamberger B et al (2005) Graves’ disease: a long-term quality-of-life follow up of patients randomized to treatment with antithyroid drugs, radioiodine, or surgery. Thyroid 15:1279–1286
Jin J, Sandoval V, Lawless ME et al (2012) Disparity in the management of Graves’ disease observed at an urban county hospital: a decade-long experience. Am J Surg 204:199–202
Elfenbein DM, Schneider DF, Havlena J et al (2015) Clinical and socioeconomic factors influence treatment decisions in Graves’ disease. Ann Surg Oncol 22:1196–1199
Torring O, Tallstedt L, Wallin G et al (1996) Graves’ hyperthyroidism: treatment with antithyroid drugs, surgery, or radioiodine–a prospective, randomized study. Thyroid Study Group. J Clin Endocrinol Metab 81:2986–2993
Mallick R, Asban A, Chung S et al (2018) To admit or not to admit? Experience with outpatient thyroidectomy for Graves’ disease in a high-volume tertiary care center. Am J Surg 216:985–989
Acknowledgements
S.C.O. received financial support from the Dedman Family Scholar in Clinical Care at the University of Texas Southwestern Medical Center.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Davis, J.R., Dackiw, A.P., Holt, S.A. et al. Rapid Relief: Thyroidectomy is a Quicker Cure than Radioactive Iodine Ablation (RAI) in Patients with Hyperthyroidism. World J Surg 43, 812–817 (2019). https://doi.org/10.1007/s00268-018-4864-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-018-4864-7