RADIOIODINE THERAPY FOR HYPERTHYROIDISM IN YOUNG-PATIENTS - PERCEPTION OF RISK AND USE

Although radioiodine is increasingly the treatment of choice in hypert hyroidism, there are regional differences in its use which reflect, in part, concerns regarding safety. We investigated attitudes amongst ge neral practitioners and consultant physicians to the role of radioiodi ne therapy, and reviewed our own radioiodine prescribing in patients a ged less than 40 to elucidate any influence of age and/or sex. We surv eyed general practitioners in the former Central Birmingham Health Dis trict and consultant physicians in the West Midlands Region to investi gate treatment preferences in hyperthyroidism and perceived risk from radioiodine of hypothyroidism, carcinogenesis and infertility. Of 230 general practitioner and 130 consultant physician respondents, less th an 1% considered radioiodine the treatment of choice in a 25-year-old female presenting with hyperthyroidism. At relapse after antithyroid d rug treatment in a 25-year-old female, only 16.5% of general practitio ners and 23.9% of physicians advocated radioiodine, the greatest numbe r preferring partial thyroidectomy. For a 65-year-old at presentation, 49.1% of general practitioners and 62.3% of physicians considered rad ioiodine the treatment of choice. More than 10% failed to note the ris k of hypothyroidism following radioiodine, while 11-34% perceived incr eased risk of malignancy or infertility. Review of our own practice de monstrated that of 100 patients given radio-iodine, 94% were cured of hyperthyroidism when reviewed at a mean of 2.4 years from latest treat ment, 70% being hypothyroid. Females given radioiodine were treated le ss promptly following diagnosis of hyperthyroidism than males (2.2 +/- 0.26 years vs. 1.6 +/- 0.4) and were more likely to have received a p receding course of antithyroid drugs (78% vs. 57%). Doubts regarding t he safety of radioiodine persist amongst doctors and are reflected in unwillingness to recommend radio-iodine therapy in young females, even at relapse of hyperthyroidism. Radioiodine is an effective treatment of hyperthyroidism in young patients, although at the cost of thyroid failure.