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Table 2 Advantages and disadvantages of surgery (total thyroidectomy) and RAI

From: How to use thionamide anti-thyroid drug in the young– what’s new?

Advantages and Disadvantages of Radio-iodine
 Advantages include:
  • Simple
  • No scar
  • No surgical risk
 Disadvantages include:
  • Best avoided in the young, pre-pubertal child if possible
  • Best avoided in large goitres where second dose may be needed
  • Need to follow safety guidance post Rx with implications in terms of school, contact with other family members etc
  • Risk of crisis (very small)
  • Can excacerbate eye disease – glucocorticoid cover may be needed
  • Fluctuating thyroid status post administration – can be addressed by a period of BR therapy with ATD stopped after ~ 4 to 6 months
  • Potential need for second dose – reduced likelihood if larger dose or (potentially) if dosimetry used
  • Must be avoided if there is a risk of pregnancy
  • Potential longer term neoplasia risk
Advantages and Disadvantages of surgery (total thyroidectomy)
 Advantages include:
  • Immediate resolution of hyperthyroidism
  • Removes goitre
 Disadvantages include:
  • Anaesthetic risks
  • Well recognised surgical risks eg bleeding
  • Scar
  • Long term hypoparathyroidism
  • Voice change (damage to recurrent laryngeal nerve or superior laryngeal nerve’s external branch)