source: Clinical Endocrinology

year: 2018

authors: Conaglen HM, Tamatea JAU, Conaglen JV, Elston MS

Background:
Thyrotoxicosis, most often caused by Graves’ disease (GD), when treated inadequately may result in premature mortality. There is little consensus as to which of the 3 treatment options available – antithyroid drugs (ATD), radioactive iodine (RAI) and surgery, is better.

Aims:
(i) To assess factors involved in treatment choice and treatment satisfaction in patients treated for Graves’ disease; (ii) To assess quality of life (QoL) following treatment of Graves’ disease.

Method:
Participants were selected from a prospective study cohort assessing thyrotoxicosis incidence and severity. Of the 172 eligible patients with Graves’ disease, 123 treated patients participated (64% had received ATD only, 11% RAI and 25% total thyroidectomy, the latter 2 usually after a period of ATD), along with 18 untreated patients with newly diagnosed Graves’ disease (overall participation rate, 73%). Consented patients completed a questionnaire detailing factors involved in treatment choice, QoL and satisfaction with treatment.

Results:
Participants reported that the most important factors in choosing a treatment were the following: the effects on activities of daily living, concern about use of radioiodine, possibility of depression or anxiety, and doctor’s recommendations. Satisfaction levels were high across all 3 treatment types. QoL 1-year following treatment was higher than in untreated patients, and comparable with other international studies.

Conclusions:
Patient satisfaction with therapy and QoL does not differ by treatment type. Therefore, clinical and social factors, in combination with patient choice and resource availability, should determine which treatment modality patients with Graves’ disease should receive.

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