3. Success rates were 50% for ATD, 93% for RAI, and 99% for surgery.
4.Median time to treatment failure was 6.8 months for ATD.
5.When patients were required to be on ATD for at least one year before assessing failure, the failure rate decreased to 25%.
6.When patients failed ATD therapy, the most common second-line therapy was re-initiation of ATD (65%).
7. Long term use of low dose ATD therapy should be the first line of treatment over radiation or surgery.
8. Adverse effects were most common with surgery. (24%).
9. I recommend long term ATD therapy to avoid the major surgery with the scar complications and long term thyroid hormone therapy.
10. Radiation therapy as radioiodine ablation today is a harder sell as people have fear of radiation effects on their body from the I/131 dose.
11. RAI/131 will also cause the patient to need thyroid hormone for life after the treatment.
12. Call me for a consultation before you sign up for surgery or radiation treatment.
310-393-8860 or secure email to firstname.lastname@example.org.
Ask for Alicia.
Patterns of Use, Efficacy, and Safety of Treatment Options for Patients with Graves’ Disease: A Nationwide Population-Based Study
Published Online:11 Mar 2020https://doi.org/10.1089/thy.2019.0132
Background: Considerable uncertainty remains about the pattern of use of treatment options for Graves’ disease (GD) and their comparative effectiveness and safety.
Methods: Between 2005 and 2013, we identified patients with GD who received antithyroid drugs (ATDs), radioactive iodine (RAI) or surgery, and were represented in a large administrative data set in the United States (OptumLabs® Data Warehouse).
Results: We identified 4661 patients with GD: mean age 48 (SD ±14) years, white (63%), and female (80%). Patients received ATD, n = 2817 (60%), RAI, n = 1549 (33%), or surgery, n = 295 (6%). Success rates were 50% for ATD, 93% for RAI, and 99% for surgery. Median time to treatment failure was 6.8 months for ATD and 3 months for RAI and surgery. When patients were required to be on ATD for at least one year before assessing failure, the failure rate decreased to 25%. Adverse effects occurred in 12% of patients receiving ATD, 6% with RAI, and 24% with surgery. Factors associated with treatment success were age >55 years (for ATD) and female sex (for RAI). About 12% of patients receiving ATD continued this treatment for >24 months as initial therapy. When patients failed ATD therapy, the most common second-line therapy was re-initiation of ATD (65%), RAI (26%), and surgery (9%). Overall, 26% of patients remain on ATD therapy (combined first or second line).
Conclusions: ATD therapy was the most common GD therapy and demonstrated the lowest efficacy and infrequent significant adverse effect profile. With one fourth of patients remaining on ATD treatment (initial or second modality treatment), it becomes imperative to determine the long-term efficacy, safety, costs, and burdens of this modality of treatment.