Table 1 Pros and cons of Graves’ disease treatments
From: Should radioiodine now be first line treatment for Graves’ disease?
Antithyroid drugs | Radioiodine | Thyroidectomy | |
|---|---|---|---|
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 |