INTERNATIONAL DIFFERENCES IN APPROACHES TO I-131 THERAPY FOR GRAVES-DISEASE - CASE SELECTION AND RESTRICTIONS RECOMMENDED TO PATIENTS IN JAPAN, KOREA, AND CHINA

Members of the American Thyroid Association (ATA), European Thyroid As sociation (ETA), Japan Thyroid Association (JTA), Korean Thyroid Assoc iation (KTA), and Chinese Thyroid Association (CTA) were surveyed inde pendently through an identical questionnaire on their management of Gr aves' disease. One of the major purposes of the survey was to determin e how expert thyroidologists in different regions of the world use thr ee different therapies available for a typical Graves' patient as well as for clinical variations provided. In this report, we summarized, c ontrasted, and interpreted the results of the surveys in three Asian c ountries by focusing on therapeutic preference of radioiodine. For the index patient with hyperthyroidism due to Graves' disease, radioiodin e was the therapy of choice for 69% of ATA respondents but only 22%, 2 2%, 11%, and 11% of ETA, CTA, JTA, and KTA respondents, respectively. The goal of radioiodine therapy in Asian countries was to restore the euthyroid state. For the case of recurrence after surgery, there was c onsensus on choosing radioiodine among all countries surveyed. To inte rpret the reluctance to advocate radioiodine therapy for a typical Gra ves' patient in Japan, a new survey concerning the current trends in r adioiodine therapy in Japan was conducted among clinical members of th e JTA. The phobia of radiation and stringent safety rules for radioact ive pharmaceuticals were the two major reasons found. Nevertheless, th e percentage of JTA respondents who aim for the euthyroid or hypothyro id state by radioiodine therapy for typical Graves' significantly incr eased compared with respondents to the former survey in 1988. Moreover , a considerable number of JTA members believe that more radioiodine t herapy should be applied for achievement of the rapid improvement of h yperthyroidism, for convenience, and for medical cost benefits.