Advantages of radioiodine over thyroidectomy in the treatment of Graves' disease
George Crile, M.D.
Department of General Surgery
Penn G. Skillern, M.D.
Department of Endocrinology
ONE of the authors of this paper is a surgeon with long experience in the surgical and medical treatment of hyperthyroidism, and the other is an internist, well versed in the use of antithyroid drugs, but both agree that radioiodine (131I) is the safest and most effective treatment for Graves' disease. Although this opinion is shared by many physicians and surgeons interested in thyroid disease, in two recent papers1, 2 it was stated that thyroidectomy was preferable to 131I. Because this conclusion appears to be based on misunderstandings or misinterpretations of facts, the purpose of this report is to clarify five of the key points in the controversy.
1. It is sometimes assumed that in a high proportion of cases it is necessary to give repeated doses of 131I and that “. . . this often requires doses in excess of 100 mc and four or more doses.” 1
Although hyperthyroidism in patients with large nodular goiters is often resistant to control with 131I, the type associated with Graves' disease is usually controlled by a single dose of from 5 to 14 mc. For example, 63 percent of 3,285 patients with Graves' disease treated with 131I at the Cleveland Clinic between 1947 and 1966 were cured by single such treatments. Fewer that 1 percent of the patients required four or more treatments, and only two of the 3,285 required doses in excess of 100 mc.
Since large hyperfunctioning nodular goiters do not shrink much after 131I treatment, and usually require . . .