Perspective from Omar El Kawkgi, MD
Disclosures: The authors report no relevant financial disclosures.
September 22, 2021
3 min read
Save

Thyroidectomy as first-line treatment for Graves’ disease reduces mortality, CVD risk

Perspective from Omar El Kawkgi, MD
Disclosures: The authors report no relevant financial disclosures.
You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Adults who underwent a thyroidectomy as first-line treatment for Graves’ disease had lower risks for all-cause mortality and cardiovascular disease than those treated with antithyroid drugs or radioactive iodine, according to study data.

Thyroidectomy also lowered the risks for atrial fibrillation, diabetes and hypertension, and was associated with lower 10-year health care costs owing to a lower relapse rate compared with antithyroid drugs or radioactive iodine, according to researchers.

Adults who underwent a thyroidectomy as first-line therapy for Graves' disease had lower risks for all-cause mortality, CVD, diabetes and hypertension compared with those using antithyroid drugs. Data were derived from Liu X, et al. Ann Surg. 2021;doi:10.1097/SLA.0000000000004828.

“This study lends support to an increased role of surgery as a first-line treatment in Graves’ disease,” Brian H.H. Lang, MBBS, MS, clinical professor and director of the Surgical Skills Training Center in the department of surgery at the University of Hong Kong, and colleagues wrote in a study published in Annals of Surgery.

Researchers conducted a retrospective cohort study of 6,385 adults (mean age, 45.6 years; 72.6% women) with a diagnosis of Graves’ disease in the Hong Kong Hospital Authority Clinical Management System who received first-line treatment with antithyroid drugs, radioactive iodine or thyroidectomy from 2006 to 2018. Adults receiving antithyroid drugs for more than 1 year were placed into the antithyroid drugs group (n = 4,784). The radioactive iodine group included those who received antithyroid drugs for less than 1 year or not at all, followed by radioactive iodine therapy (n = 1,274). The thyroidectomy group included those who had thyroidectomy preceded by less than 1 year of antithyroid drugs or no treatment with antithyroid drugs (n = 327). Primary outcomes included risks for CVD, atrial fibrillation, psychological disease, diabetes, hypertension and all-cause mortality after treatment. Additional outcomes included 10-year direct cumulative health care costs and changes in comorbidity profile.

Thyroidectomy lowers risk for mortality, CVD

Compared with adults receiving only antithyroid drug therapy, those who underwent a thyroidectomy had lower risks for all-cause mortality (HR = 0.363; 95% CI, 0.332-0.396), CVD (HR = 0.216; 95% CI, 0.195-0.239), atrial fibrillation (HR = 0.103; 95% CI, 0.085-0.124), psychological disease (HR = 0.279; 95% CI, 0.258-0.301), diabetes (HR = 0.341; 95% CI, 0.305-0.381) and hypertension (HR = 0.673; 95% CI, 0.632-0.718). Adults in the radioactive iodine group had lower risks for all-cause mortality (HR = 0.931; 95% CI, 0.882-0.982), CVD (HR = 0.784; 95% CI, 0.742-0.828), atrial fibrillation (HR = 0.622; 95% CI, 0.578-0.67) and psychological disease (HR = 0.895; 95% CI, 0.855-0.937), and higher risks for diabetes (HR = 1.081; 95% CI, 1.014-1.152) and hypertension (HR = 1.255; 95% CI, 1.203-1.31) than those receiving only antithyroid drugs. Compared with radioactive iodine therapy, adults who underwent a thyroidectomy had lower risks for all-cause mortality (HR = 0.446; 95% CI, 0.408-0.487), CVD (HR = 0.296; 95% CI, 0.267-0.328), atrial fibrillation (HR = 0.256; 95% CI, 0.212-0.308), psychological disease (HR = 0.303; 95% CI, 0.28-0.327), diabetes (HR = 0.269; 95% CI, 0.242-0.3) and hypertension (HR = 0.555; 95% CI, 0.523-0.589).

Lower 10-year health care costs with thyroidectomy

The thyroidectomy group had a lower relapse rate (2.41%) compared with radioactive iodine therapy (19.53%) or antithyroid drug treatment (75.6%). For those receiving radioactive iodine therapy, two doses of treatment increased the likelihood for all-cause mortality (OR = 2.79; 95% CI, 1.761-4.422) and hypertension (OR = 1.793; 95% CI, 1.125-2.858) compared with those receiving only one dose.

Adults who underwent thyroidectomy had the highest annual health care expenses in the first year of follow-up. The costs among the three groups became similar by the fifth year of follow-up. After 10 years, the thyroidectomy group had a lower cumulative health cost (mean health costs, $20,202) compared with the antithyroid drug group ($23,915) and the radioactive iodine group ($24,260).

“This long-term cost-saving might have been a result of the lower relapse rate, which led to a lower chance of continuous monitoring and treatment, including definitive radioactive iodine and surgery later,” the researchers wrote. “Regarding cost-effectiveness as an important factor for consideration in the choice of Graves’ disease therapy, our results favored surgery with lower long-term health care costs.”