Trusted Resources: Evidence & Education
Scientific literature and patient education texts
Clinical and Socioeconomic Factors Influence Treatment Decisions in Graves’ Disease
source: Annals of Surgical Oncology
year: 2015
authors: Elfenbein DM, Schneider DF, Havlena J, Chen H, Sippel RS
summary/abstract:Background:
Definitive treatment of Graves’ disease includes radioactive iodine (RAI) and thyroidectomy, but utilization varies. We hypothesize that, in addition to clinical reasons, there are socioeconomic factors that influence whether a patient undergoes thyroidectomy or RAI.
Methods:
Patients treated for Graves’ disease between August 2007 and September 2013 at our university hospital were included. A comparative analysis of clinical and socioeconomic factors was completed.
Results:
Of 427 patients, 300 (70 %) underwent RAI, whereas 127 (30 %) underwent surgery. Multiple factors were associated with surgery: younger age (mean 36 vs. 41 years, p < 0.01), female gender (33 vs. 19 % males, p = 0.01), black race (56 vs. 28 % nonblack, p < 0.01), Medicaid or uninsured (43 vs. 27 % private insurance or Medicare, p < 0.01), ophthalmopathy (38 vs. 26 %, p < 0.01), goiter (35 vs. 23 %, p < 0.01), and lowest quartile of median household income (38 vs. 27 % upper three quartiles, p = 0.03). Thyroidectomy increased annually, with 52 % undergoing surgery during the final year (p < 0.01). Adjusting for confounding, younger age (odds ratio [OR] 1.04; 95 % confidence interval [CI] 1.02, 1.05), female gender (OR 2.06; 95 % CI 1.06, 4.01), ophthalmopathy (OR 2.35; 95 % CI 1.40, 3.96), and later year of treatment (OR 1.66; 95 % CI 1.41, 1.95) remained significantly associated with surgery.
Conclusions:
Surgery has now become the primary treatment modality of choice for Graves’ disease at our institution. Clinical factors are the main drivers behind treatment choice, but patients with lower SES are more likely to have clinical features best treated with surgery, underlying the importance of improving access to quality surgical care for all patients.
DOI: 10.1245/s10434-014-4095-6
read more full text
Related Content
-
Thyroid Carcinoma in Graves’ Disease: A Meta-AnalysisBackground: The incidence of thyroid ca...
-
Thyroid-Associated Ophthalmopathy After Treatment for Graves’ Hyperthyroidism With Antithyroid Drugs or Iodine...Context: Previous randomized trials hav...
-
Robert B. Penne, MD, FACSRobert B. Penne, MD is Chief of the Ocul...
-
The British Association of Endocrine and Thyroid SurgeonsThe British Association of Endocrine and...
-
Medication for Graves’ Disease in ChildrenDoctors at Hassenfeld Children’s Hospi...
-
Prevention of Overt Hypothyroidism Following Radioactive Iodine Therapy for Graves’ Disease By Early Initiatio...Background: Radioactive iodine (RAI) th...
-
Management of Thyroid Eye Disease in the United Kingdom: A Multi-Centre Thyroid Eye Disease AuditThis article aims to provide baseline da...
To improve your experience on this site, we use cookies. This includes cookies essential for the basic functioning of our website, cookies for analytics purposes, and cookies enabling us to personalize site content. By clicking on 'Accept' or any content on this site, you agree that cookies can be placed. You may adjust your browser's cookie settings to suit your preferences. More Information
The cookie settings on this website are set to "allow cookies" to give you the best browsing experience possible. If you continue to use this website without changing your cookie settings or you click "Accept" below then you are consenting to this.