The long term effects of radio-iodine therapy versus antithyroid medications on Graves' disease

Objectives Anti-thyroid medication and radioiodine are mostly used treatment for Graves' disease. However, the possible differences between anti-thyroid medication and radioiodine with respect to long-term clinical outcomes are insufficiently known. To assess the long term effects of radio-iodine therapy verses anti-thyroid drugs for Graves' disease.

Methods Studies were obtained from computerized searches of MEDLINE (1946 to March 2012), EMBASE (1980 to March 2012), The Cochrane Library (Issue January 2012) . Randomised controlled clinical trials comparing the effects of radioiodine therapy versus anti-thyroid medications for Graves' disease with at least two years follow up.

Results Three English RCTs involving 657 patients with Graves' disease were included in this review. Altogether 322 patients were randomised to radioiodine therapy, while 335 to anti-thyroid medication. There was no evidence of a significant difference in quality of life in terms of mental and physical components between radio-iodine and anti-thyroid medication (one trial, mean difference 1.00 and 2.00, 95% CI -3.21 to 5.21 and -1.58 to 5.58, respectively). Radio-iodine for GD showed significant benefits in cure rate (three trials, RR 8.80, 95% CI 5.64 to13.73), adverse effects (three trials, RR 0.03, 95% CI 0.00 to 0.18) and recurrence of hyperthyroidism (three trials, RR 0.28, 95% CI 0.18 to 0.43). Radio-iodine for GD has significantly higher cost (two trials, mean difference 60.6, 95% CI 44.07 to 77.14).

Conclusions Results from three randomised controlled clinical trials suggest that the radio-iodine is more effective than ATD for Graves' disease with significant benefits on adverse effects and recurrence of hyperthyroidism. Therefore, radio-iodine should be recommended for patients with Graves' disease. However, radio-iodine therapy showed significant higher cost in ATD. The cost was only compared in two countries (Sweden and Iran). Better quality randomised controlled trials are needed to investigate the quality of life and cost by the two treatments.

Research Support This study was supported by the National Natural Science Fund (no. 81271612).