The Treatment of Graves Disease

Abstract

To the Editor.— The authors cited the paper by Nofal et al to demonstrate the high incidence of hypothyroidism following radioactive iodine therapy, but failed to mention that in the same study the rate of thyroid hypofunction ten years after subtotal thyroidectomy was 43%. Although it is generally agreed that the incidence of hypothyroidism is higher following iodine 131 therapy than after surgery, the difference is not tremendous. Furthermore, recent study by Wood, Peterson, and Ingbar concludes that progressive impairment of thyroid function is a frequent termination of the natural history of Graves disease. Thus, untreated patients, as well as those treated with radioactive iodine administration or subtotal thyroidectomy, may develop hypothyroidism that can be adequately managed with daily administration of one tablet of a thyroid preparation. Recurrence of hyperthyroidism occurs in up to 17.2% of patients with Graves disease who undergo thyroidectomy (Hershman), while 90% of patients are cured