Endocrine Abstracts

Radioiodine is indeed the best first line treatment in all patients with Graves’ disease. Except in those who want to try for pregnancy in the next few months, those with significant child care or work responsibilities that will not allow them to take the necessary radioprotection precautions, those who are breast feeding or who smoke and have ophthalmopathy, and those who have been exposed to stable iodine. Oh, and those who are not very happy to accept the risk of permanent hypothyroidism rather than have an initial trial of a treatment which will promptly and reliably reverse their hyperthyroid symptoms, while giving them an almost evens chance of a cure without hypothyroidism (a condition which we now know is not quite as appealingly straightforward to treat as it once was). In cost benefit terms there is not much in it, and in side effect terms the risks of antithyroid drug treatment need to be set against the rather large fraction of iatrogenic hypothyroidism which is not properly controlled. ‘All patients’ of course include children, a further Graves’ subgroup in which eminence-based rather than evidence-based medicine is practised. Despite a recent call for wider use of radioiodine in childhood, the younger the child the less enthusiastic most paediatricians are to use this. In truth there is not an ideal treatment for Graves’ disease and a nuanced approach which takes into full account the patient’s circumstances is the only way to decide which treatment is best employed first time around.