Engelbrecht-Wiggans Emily A, Carlisle Kendyl, Yunasan Elvina, Fan Caleb, Munir Kashif M, Terhune Julia, Turner Doug, Hu Yinin
Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Department of Surgery, University of Maryland Medical Center, Baltimore, MD. Electronic address: https://twitter.com/CarlisleKendyl.
Surgery. 2025 Jan;177:108828. doi: 10.1016/j.surg.2024.05.050. Epub 2024 Oct 11.
Common treatments for Graves' disease include antithyroid drugs (ATD), radioactive iodine (RAI), and surgery. RAI avoids surgical morbidity, but rate and durability of remission varies across studies. This study directly compared the long-term results of Graves' disease treated by surgery versus RAI and hypothesized that RAI would be associated with lower rates of long-term biochemical remission and higher likelihood of retreatment.
This retrospective cohort study included individuals diagnosed with Graves' disease who were treated surgically, with RAI, or both at a tertiary referral center. Definitive retreatment was defined as additional RAI or surgery after index treatment, and retreatment was defined as requiring ATD or a second definitive treatment after index treatment. Remission was defined by normalization of thyroid stimulating hormone without retreatment at 6 months.
Index definitive therapy was total thyroidectomy for 72 patients and RAI for 104 patients. The median follow-up time was 3.6 years. The rate of remission at 6 months in the RAI group (68.8%) was lower than that in the surgery group (98.6%) (odds ratio: 0.03, P < .001). Patients who underwent index RAI experienced a significantly higher cumulative incidence of any retreatment at all time points than those who underwent index surgery (P < .001). Among RAI patients who achieved euthyroidism within 6 months, 19% developed subsequent relapse requiring ATD therapy or retreatment.
The need for retreatment after index therapy for Graves' disease is significantly lower after thyroidectomy than after RAI.
格雷夫斯病的常见治疗方法包括抗甲状腺药物（ATD）、放射性碘（RAI）和手术。放射性碘可避免手术并发症，但不同研究中缓解率和缓解的持久性有所不同。本研究直接比较了手术与放射性碘治疗格雷夫斯病的长期结果，并假设放射性碘治疗会导致较低的长期生化缓解率和较高的再次治疗可能性。
这项回顾性队列研究纳入了在一家三级转诊中心接受手术、放射性碘治疗或两者皆有的格雷夫斯病患者。明确的再次治疗定义为在首次治疗后进行额外的放射性碘治疗或手术，再次治疗定义为在首次治疗后需要抗甲状腺药物治疗或第二次明确治疗。缓解定义为在6个月时促甲状腺激素正常化且无需再次治疗。
首次明确治疗中，72例患者接受了全甲状腺切除术，104例患者接受了放射性碘治疗。中位随访时间为3.6年。放射性碘治疗组6个月时的缓解率（68.8%）低于手术组（98.6%）（优势比：0.03，P <.001）。接受首次放射性碘治疗的患者在所有时间点的任何再次治疗累积发生率均显著高于接受首次手术的患者（P <.001）。在6个月内实现甲状腺功能正常的放射性碘治疗患者中，19%随后出现复发，需要抗甲状腺药物治疗或再次治疗。
格雷夫斯病首次治疗后，甲状腺切除术后再次治疗的需求明显低于放射性碘治疗后。
