Graves’ disease is an autoimmune disorder characterized by over-activity of the thyroid gland (hyperthyroidism). The thyroid is an important gland that secretes hormones to regulate body metabolism. The symptoms of Graves’ disease are therefore not limited to a particular area of the body, and can be of special concern if diagnosed in pre-pubescent children. Symptoms include anxiety, weight loss, impaired skeletal mineralization, fatigue, frequent bowel movements, muscle weakness, insomnia, goiter, irregular heartbeat, poor academic performance and many others. People with Graves’ disease are also more likely to develop thyroid cancer than those without. Graves’ disease rarely resolves itself spontaneously; for this reason the treatment of hyperthyroidism is essential for the patient’s well-being.
Treatment of Graves’ disease falls into three categories: drug therapy, surgery, and radioiodine (I-131) therapy. In a clinical review of these treatment options, authors Rivkees, Sklar, and Freemark present a very strong case for radioiodine for several reasons. The group has shown it to be a more effective treatment of hyperthyroidism than either drug therapy or surgery, especially in children. Using drug therapy, the one-year remission rate for children is between 17% and 30%. However, for children treated with a single dose of radioiodine, the one-year remission rate is between 90% and 95%. Surgical treatment of hyperthyroidism is most effective when the entire thyroid gland is removed. Cure rates for this type of surgery are around 97% in children and adults. Total thyroidectomy, as the procedure is known, is a complicated surgery and success is contingent on the expertise of the surgeon.
The group has also shown radioiodine to be the safest of the three treatment options. Anti-thyroid drugs can have serious side-effects, particularly in children. Documented complications include skin rash, arthritis, nausea, hepatitis, and even death. Patients treated with these drugs were also shown to be 10-20 times more likely to develop a thyroid cancer than those treated with radioiodine. The surgical option, a thyroidectomy, is safer but still risky. For example, 1 in 50 thyroidectomies result in permanent vocal cord paralysis. Death is always a risk with any surgical procedure, and the physical pain and monetary cost are unavoidable. As a third option, treatment with radioiodine is much safer. The most observed side-effect is a worsening of an already present eye disease, which occurs in 3-5% of patients. Transient thyroid pain develops in 5% of patients, but typically lasts only 1-3 days after treatment. Nausea is rare, and there have been no reported deaths from radioiodine treatment. The risk of developing thyroid cancer after treatment with radioiodine is much lower as well. After treatment of adults with Graves’ disease with I-131, rates of thyroid cancer were not increased at all.
The work of Rivkees, Sklar, and Freemark has shown I-131 to be a particularly effective treatment of Graves’ disease and hyperthyroidism, especially for children. Not only is it the safest and most effective treatment, it is also the most cost-effective. This paper is successful in communicating the benefits of I-131, but it also demonstrates that there are instances where surgery or drug therapy may be required. For the majority of patients suffering from Graves’ disease, however, I-131 has been something of a wonder drug.