GRAVES HYPERTHYROIDISM - TREATMENT WITH ANTITHYROID DRUGS, SURGERY, OR RADIOIODINE - A PROSPECTIVE, RANDOMIZED STUDY

To analyze the benefits and risks of three common treatments, we rando mly assigned 179 patients with Graves' hyperthyroidism as follows: 60 patients, 20-34 yr of age (young adults), received antithyroid drugs f or 18 months (medical) or subtotal thyroidectomy (surgical), and 119 p atients, 35-55 yr of age fold adults), received medical, surgical, or radioiodine (iodine-131) treatment. The follow-up time was at least 48 months. Antithyroid drugs, surgery, or iodine-131 treatment normalize d the mean serum hormone levels within 6 weeks. The risk of relapse wa s highest in the medically treated young and old adults (42% vs. 34%), followed by that in those treated with iodine-131 (21%) and that in t he surgically treated young and old adults (3% vs. 8%), respectively. Elevated TSH receptor antibodies at the end of medical therapy or incr easing TSH receptor antibodies values after medical or surgical treatm ent increased the probability of relapse. Development or worsening of ophthalmopathy was not associated with relapse per se. Ninety percent of the subjects in all groups were satisfied with the treatment they r eceived. No significant difference in sick-leave due to Graves' or oth er diseases was seen during the first 2 yr after initiation of therapy . The increased risk of ophthalmopathy in patients with high serum T-3 levels, especially when treated with iodine-131, and the relatively h igh frequency of relapse after treatment with antithyroid drugs are im portant factors to consider when selecting therapy for Graves' disease .