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

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)