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Radioiodine or surgical treatment for patients with hyperthyroidism

Hyperthyroidism is a condition that occurs due to excessive production of thyroid hormone by the thyroid gland. Symptoms of hyperthyroidism may include irritability, muscle weakness, sleeping problems, a fast heartbeat and unintentional weight loss. It can be caused by Graves' disease (an autoimmune disease), multinodular goiter, toxic adenoma or inflammation of the thyroid. There are three main treatment options for hyperthyroidism; radioiodine therapy, medications, and thyroid surgery (thyroidectomy).

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Question

Which systematic reviews compare the effectiveness of radioiodine therapy and thyroid surgery for patients with hyperthyroidism?

Studies were identified by a literature search of three electronic databases. The full search strategies are available below. We have only included systematic reviews written in English or Swedish. Thesis’s, guidelines and umbrella reviews have been excluded. A total of 193 abstracts were reviewed, and of these, 43 articles were assessed in full. Abstracts as well as full text articles were assessed by one person. 11 systematic reviews, one guideline and 3 health economic studies were found relevant in relation to the question and are listed below.

Identified literature

  1. Bahn Chair RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011;21:593-646.
  2. Sundaresh V, Brito campana J, Wang Z, Prokop L, Stan MN, Murad MH, et al. Comparative effectiveness of the therapeutic options for graves' disease: A systematic review and network meta-analysis. Thyroid 2012;22:A86-A87.
  3. Ren Z, Qin L, Wang JQ, Li Y, Li J, Zhang RG. Comparative Efficacy of Four Treatments in Patients with Graves' Disease: a Network Meta-analysis. Exp Clin Endocrinol Diabetes 2015;123:317-22.
  4. Bartsch DK, Luster M, Buhr HJ, Lorenz D, Germer CT, Goretzki PE. Indications for the Surgical Management of Benign Goiter in Adults. Dtsch Arztebl Int 2018;115:1-7.
  5. Cirocchi R, Trastulli S, Randolph J, Guarino S, Di RG, Arezzo A, et al. Total or near-total thyroidectomy versus subtotal thyroidectomy for multinodular non-toxic goitre in adults. Cochrane Database of Systematic Reviews 2015.
  6. Acharya SH, Avenell A, Philip S, Burr J, Bevan JS, Abraham P. Radioiodine therapy (RAI) for Graves' disease (GD) and the effect on ophthalmopathy: a systematic review. Clin Endocrinol (Oxf) 2008;69:943-50.
  7. Genovese BM, Noureldine SI, Gleeson EM, Tufano RP, Kandil E. What is the best definitive treatment for Graves' disease? A systematic review of the existing literature. Ann Surg Oncol 2013;20:660-7.
  8. Li HX, Xiang N, Hu WK, Jiao XL. Relation between therapy options for Graves' disease and the course of Graves' ophthalmopathy: a systematic review and meta-analysis. J Endocrinol Invest 2016;39:1225-1233.
  9. Nygaard B. Hyperthyroidism (primary). BMJ Clin Evid 2010;2010.
  10. Stalberg P, Svensson A, Hessman O, Akerstrom G, Hellman P. Surgical treatment of Graves' disease: evidence-based approach. World J Surg 2008;32:1269-77.
  11. Tallstedt L, Lundell G, Torring O, Wallin G, Ljunggren JG, Blomgren H, et al. Occurrence of ophthalmopathy after treatment for Graves' hyperthyroidism. The Thyroid Study Group. N Engl J Med 1992;326:1733-8.
  12. Vazquez-Chavez C, Nishimura Meguro E, Espinosa Said L, Delgado Falfari A, Sainz de Viteri M. [Effect of the treatment of hyperthyroidism on the course of exophthalmos]. Rev Invest Clin 1992;44:241-7.
  13. Azizi F, Amouzegar A. Management of hyperthyroidism during pregnancy and lactation. Eur J Endocrinol 2011;164:871-6.
  14. Ma C, Kuang A, Xie J, Liu GJ. Radioiodine treatment for pediatric Graves' disease. In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, Food and Drug Toxicology Research Centre, National Institute of Nutrition, Hyderabad, India. DO - 10.1002/jat.2718 [doi] England; 2008.
  15. Burch HB, Cooper DS. Management of Graves Disease: A Review. Jama 2015;314:2544-54.
  16. Donovan PJ, McLeod DS, Little R, Gordon L. Cost-utility analysis comparing radioactive iodine, anti-thyroid drugs and total thyroidectomy for primary treatment of Graves' disease. Eur J Endocrinol 2016;175:595-603.
  17. In H, Pearce E, Wong A, Burgess J, McAneny D, Rosen J. Treatment options for Graves disease: a cost-effectiveness analysis (Provisional abstract). Journal of the American College of Surgeons 2009;209:170-179.
  18. Zanocco K, Heller M, Elaraj D, Sturgeon C. Is subtotal thyroidectomy a cost-effective treatment for Graves disease? A cost-effectiveness analysis of the medical and surgical treatment options (Provisional abstract). Surgery 2012;152:164-172.
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Project group

Christel Hellberg and Emin Hoxha Ekström at SBU.

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