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Table 1 Pros and cons of Graves’ disease treatments

From: Should radioiodine now be first line treatment for Graves’ disease?

 Antithyroid drugsRadioiodineThyroidectomy
Pros• Prospect of euthyroid remission
• Permanent hypothyroidism - rare
• Used in pregnancy
• Non-invasive
• Rapid control (weeks)
• Cure rates ~ 80–90%
• Single outpatient treatment
• Side-effects minor and rare
• Cost-effective
• Rapid control (days)
• Cure rates ~ 100% for total thyroidectomy
• Useful in patients with co-existent primary hyperparathyroidism, malignancy, large goitres or airway compression
Cons• Low remission rates ~ 45%
• Risk of relapse in future pregnancy or postpartum period
• 12–18 months of treatment required
• Major drug side effects: agranulocytosis, liver toxicity, cholestatic liver disease, ANCA positive vasculitis, acute pancreatitis
• Risk of birth defects if used in first trimester of pregnancy
• Aggravation of orbitopathy
• Permanent hypothyroidism
• Radiation restrictions after treatment
• Contraindicated in pregnancy due to risks of fetal anomalies and fetal hypothyroidism
• Contraindicated in individuals imminently planning pregnancy
• Need to wait 6 months after treatment before conception or fathering a child
• Anaesthetic risks
• Risk of permanent hypoparathyroidism
• Risk of recurrent laryngeal nerve damage
• Permanent hypothyroidism
• Neck scar
• Best avoided in pregnancy due to surgical and anaesthetic risks on fetus and mother