L. Wartofsky, RADIOIODINE THERAPY FOR GRAVES-DISEASE - CASE SELECTION AND RESTRICTIONS RECOMMENDED TO PATIENTS IN NORTH-AMERICA, Thyroid, 7(2), 1997, pp. 213-216
Each of the three major therapies for Graves' disease has its own adva
ntages, disadvantages, indications, and contraindications. Today, radi
oactive iodine (RAI) therapy is the most commonly employed means of th
erapy for Graves' disease in the United States, with approximately 70%
of patients so treated after initial presentation and an additional f
raction of arguably 10-15% treated with RAI after failure of antithyro
id drugs or surgery. RAI therapy is acknowledged to have the clear-cut
advantage of being safe, with very low morbidity and cost. The indica
tions for RAI therapy are clear and noncontroversial for most patients
with Graves' disease. Moreover RAI treatment is employed by some thyr
oidologists for subclinical thyrotoxicosis (normal T-4 or T-3 but imme
asurable TSH), particularly in patients > age 45 due to risks of atria
l fibrillation. RAI therapy is not considered indicated or is contrain
dicated during breast feeding and in pregnancy, subacute thyroiditis,
postpartum thyroiditis, struma ovarii, pituitary (TSH-driven) hyperthy
roidism, euthyroid hyperthyroxinemia, and thyroid hormone resistance.
Opinions vary on the use of RAI therapy in children with Craves' disea
se; generally, a lower age cutoff of 17 years is acceptable in most cl
inics. Even more controversial is whether RAI therapy in the presence
of Graves' ophthalmopathy constitutes a risk for worsening ophthalmopa
thy. Resolution of this latter issue awaits more definitive studies, b
ut RAI therapy is likely to remain the first choice for most patients
with Graves' disease.