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 randomized controlled trials (RCTs) involving 425 adults with Graves disease across 11 Swedish outpatient care centers. Among these, 221 patients were randomized to methimazole (Tapazole) therapy for 18 months and 204 were randomized to a single dose of radioactive iodine therapy. The follow-up period ranged from two to 21 years after treatment completion, depending on the observed outcome. Other RCTs were excluded for reasons such as having a follow-up duration of less than two years (four RCTs), including patients who had received other treatment for Graves disease before the study intervention (one RCT), using inadequate randomization (one RCT), and examining other non-Graves thyroid disorders in the same study (one RCT).

Health-related quality of

Author disclosure: No relevant financial affiliations.


show all references

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



Copyright © 2017 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in Pubmed


Mar 15, 2018

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article