# The decline of iodine therapy in the treatment of Graves’ disease in a hospital center: a 20-year analysis

## TL;DR

Over 20 years, the use of radioactive iodine therapy for Graves’ disease dropped significantly at a hospital, with more patients receiving drug treatment first.

## Contribution

The study reveals a significant decline in iodine therapy use for Graves’ disease over two decades in a single hospital center.

## Key findings

- Only 14.6% of patients received radioactive iodine therapy in the later period compared to 64% in the earlier period.
- The duration of antithyroid drug therapy before RAI increased significantly in the later group.
- Radioiodine therapy remained effective and safe despite its reduced use.

## Abstract

To evaluate and describe the changes in the therapeutic approach to Graves’
disease at a tertiary hospital center over a 20-year period, with an
emphasis on the frequency of prescription and the timing of radioactive
iodine indication.

We conducted a retrospective analysis of data from medical records of
patients recently diagnosed with Graves’ disease (GD) and followed up at a
single institution during two consecutive periods: Group A diagnosed between
2002 and 2010, and Group B between 2011 and 2022. We analyzed the percentage
of patients who underwent iodine therapy and were considered to have failed
therapy if they did not achieve hypothyroidism or euthyroidism, comparing
the results between both groups.

A total of 597 GD patients were included, of which 223 underwent radioactive
iodine (RAI) therapy (37.35%). In Group A, 176 patients (64%) received RAI
treatment, whereas, in Group B, only 47 patients were given this therapeutic
indication (14.6%) (p < 0.001). The reduction in RAI prescriptions
between both periods was independent of the therapeutic indication.
Interestingly, RAI prescription due to relapse after clinical treatment was
uncommon in both study groups. There was a significant increase in the
duration of antithyroid drug (ATD) therapy before RAI prescription in Group
B compared to Group A.

Significant changes were observed in GD treatment, with a decline in the use
of RAI as a first-line or salvage therapy. Nonetheless, radioiodine therapy
remained an effective and safe treatment modality with successful cure
rates.