Cochrane for Clinicians

Putting Evidence into Practice

Radioactive Iodine Therapy vs. Antithyroid Medications for Graves Disease

 

Am Fam Physician. 2017 Mar 1;95(5):292-293.

Author disclosure: No relevant financial affiliations.

Clinical Question

How do radioactive iodine therapy and antithyroid medications compare for the treatment of Graves disease?

Evidence-Based Answer

Radioactive iodine therapy and antithyroid medications produce similar health-related quality-of-life outcomes in patients with Graves disease. Radioactive iodine therapy is an appropriate choice for patients who prefer definitive treatment. Antithyroid medications are appropriate in patients attempting to avoid long-term thyroid hormone therapy and should be considered in those with increased risk of Graves ophthalmopathy, such as smokers.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Graves disease is the most common cause of hyperthyroidism in the United States. Although radioactive iodine therapy is the most commonly used treatment for Graves disease in the United States, patients in Europe and Japan are more likely to receive antithyroid medications or surgical thyroidectomy.2,3 This Cochrane review compared radioactive iodine therapy with antithyroid medications for quality-of-life outcomes, improvement or prevention of Graves ophthalmopathy, relapse rates, and cost-effectiveness.1

This review included two ra

Author disclosure: No relevant financial affiliations.

REFERENCES

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1. Ma C, Xie J, Wang H, Li J, Chen S. Radioiodine therapy versus antithyroid medications for Graves' disease. Cochrane Database Syst Rev. 2016;(2):CD010094....

2. Burch HB, Burman KD, Cooper DS. A 2011 survey of clinical practice patterns in the management of Graves' disease. J Clin Endocrinol Metab. 2012;97(12):4549–4558.

3. Bartalena L, Burch HB, Burman KD, Kahaly GJ. A 2013 European survey of clinical practice patterns in the management of Graves' disease. Clin Endocrinol (Oxf). 2016;84(1):115–120.

4. Burch HB, Cooper DS. Management of Graves disease: a review [published correction appears in JAMA. 2016;315(6):614]. JAMA. 2015;314(23):2544–2554.

5. Bahn RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists [published corrections appear in Thyroid. 2012;22(11):1195 and Thyroid. 2011;21(10):1169]. Thyroid. 2011;21(6):593–646.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.


 

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