Medication vs. radioablation for Graves' disease: how do they compare?
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The benefits are similar; the risks vary. Treating Graves' disease initially with medication or radioablation (or surgery) produces comparable resolution of hyperthyroidism at 2 years (strength of recommendation [SOR]: B, a randomized clinical trial [RCT]). The goal of radioablation is lifelong hypothyroidism. While radioablation doesn't appear to increase the risk of neoplasia, “theoretical concerns” have led to the recommendation that it not be used for children younger than 5 years (SOR: C, expert opinion). Radioablation carries a higher risk of thyroid-associated ophthalmopathy (TAO) than medical therapy (SOR: B, an RCT and a lower-quality meta-analysis). Between 9% and 16% of patients are unable to tolerate medical therapy, mainly because of rash but also because of agranulocytosis (SOR: A, meta-analysis).
Journal of Family Practice, 61(5) 2012: 294-295.