RADIOIODINE THERAPY FOR GRAVES-DISEASE - CASE SELECTION AND RESTRICTIONS RECOMMENDED TO PATIENTS IN NORTH-AMERICA

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.