Ford H C, Delahunt J W, Feek C M
Department of Pathology, Wellington School of Medicine.
N Z Med J. 1991 Jun 26;104(914):251-2.
to compare treatment of Graves' disease in New Zealand with treatment in Europe and the United States of America (USA).
we circulated a questionnaire used in recent surveys in Europe and USA to all specialist physicians in New Zealand registered with the Medical Council. In the questionnaire a patient with uncomplicated Graves' disease was given as an index case, followed by eight clinical variations with regard to goitre size, severity, sex, age and previous treatment.
two hundred and ninety-six (79%) out of 374 physicians responded to a preliminary letter asking whether they would be willing to participate in the survey. Of the respondents 71 (24%) saw more than two patients with Graves' disease per year and were included in the analysis (186 saw fewer than two cases per year and 39 failed to return questionnaires). For the index case, 55% of New Zealand respondents would treat with antithyroid drugs, 41% with radioiodine and 4% with surgery. For the index case and its variations the use of radioactive iodine by New Zealand physicians was greater than their European, but less than their American, counterparts. Surgery was infrequently recommended in any of the countries except for the patient with a large goitre, for whom 24% of New Zealand and 51% of European respondents would recommend subtotal thyroidectomy.
we have demonstrated a spectrum of behaviour by physicians in the treatment of Graves' disease based on infrequent use of surgery and the willingness to use radioactive iodine instead of treatment with antithyroid drugs. New Zealand physicians appear to be more conservative in the use of radioiodine than their American, but less than their European counterparts.
