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Aust N Z J Med. 2000 Oct;30(5):559-66. Related Articles, Links

Management of Graves' disease in Australia.

Walsh JP.

Department of Endocrinology and Diabetes, Sir Gairdner

Hospital, Perth, WA, USA. john.walsh@...

BACKGROUND: Surveys of physicians in Europe, the USA and elsewhere

have shown marked international differences in the management of

Graves' disease. There are no comparable data on clinical practice

in Australia. AIMS: To examine the current management of Graves'

disease by Australian endocrinologists, particularly controversial

aspects of management. METHODS: A questionnaire, modified from

previous studies, was sent to members of the Endocrine Society of

Australia, asking how they would manage a 43-year-old female with a

first episode of Graves' disease. Eight variations on this index

case (goitre size, age, sex, severity, recurrent disease) were then

introduced. A novel ninth variation, recurrent Graves' disease

accompanied by moderate ophthalmopathy, was added. RESULTS:

Responses from 130 endocrinologists who regularly managed Graves'

disease in adults were analysed. For the index case, medical

treatment with antithyroid drugs was recommended by 81% of

respondents and radioiodine by 19%. Most respondents also

recommended medical treatment for a patient aged 19 years, a patient

with a large goitre, no goitre or severe hyperthyroidism. For an

older patient aged 71 years, however, 57% of endocrinologists

recommended radioiodine, and the remainder medical treatment. For

recurrent Graves' disease after previous medical treatment, 76% of

respondents recommended radioiodine, 22% medical treatment and 2%

surgery. By contrast, for an identical case accompanied by moderate

ophthalmopathy, 54% recommended medical treatment, 27% surgery and

only 19% radioiodine. CONCLUSIONS: Most endocrinologists in

Australia recommend medical treatment for a first episode of Graves'

disease. Radioiodine is used mainly in older patients and for

recurrent disease. In the presence of significant ophthalmopathy,

most endocrinologists avoid the use of radioiodine.