2025 Volume 118 Issue 12 Pages 913-919
There are three established treatment options for Graves’ disease: antithyroid drugs (ATD), radioiodine therapy (RAI), and surgery. While ATDs are often selected as the first-line treatment, the optimal approach when ATDs cannot be used or when transitioning from ATDs to other treatment options remains unclear. In this study, we attempted to analyze the factors influencing the choice between RAI and surgery for the aforementioned patients referred to our department. During the study period, 141 patients (56.4%) were treated with RAI and 109 (43.6%) by surgery; 96% of patients had received prior treatment with ATDs. Among those undergoing surgery, in 38.5% of patients, surgery was unavoidable as RAI was contraindicated for reasons such as pregnancy, breastfeeding, ophthalmopathy, adolescence, comorbid thyroid cancer, or strong desire of the patient to avoid RAI. The remaining 61.5% opted for surgery based on several factors, including younger age, severe adverse reactions to ATDs, history of thyroid crisis, and greater thyroid weight. While these factors independently contributed to the decision to select surgery, they did not entirely exclude the possibility of RAI treatment. The final decision was influenced by both clinical factors and the preferences of the patients and clinicians, indicating that the treatment choice can vary across different medical facilities. This study highlights the importance of a personalized approach in selecting between RAI and surgery for patients with Graves’ disease.
