Journal of the American College of Surgeons
Volume 209, Issue 2 , Pages 170-179.e2 , August 2009

Treatment Options for Graves Disease: A Cost-Effectiveness Analysis

Abstract presented at the American College of Surgeons 94th Annual Clinical Congress, San Francisco, CA, October 2008.

  • Haejin In, MD, MBA

      Affiliations

    • Department of Surgery, Boston Medical Center, Boston, MA
    • Corresponding Author InformationCorrespondence address: Haejin In, MD, Department of Surgery, Boston Medical Center, 88 East Newton St, #C515, Boston, MA 02118
    • ,
  • Elizabeth N. Pearce, MD, MSc

      Affiliations

    • Department of Endocrinology, Boston Medical Center, Boston, MA
    • ,
  • Arthur K. Wong, MBA, MSc

      Affiliations

    • Department of Surgery, Boston Medical Center, Boston, MA
    • ,
  • James F. Burgess, PhD

      Affiliations

    • Veterans Administration Boston Healthcare System, Boston University School of Public Health, Boston, MA
    • ,
  • David B. McAneny, MD, FACS

      Affiliations

    • Department of Surgery, Boston Medical Center, Boston, MA
    • ,
  • Jennifer E. Rosen, MD, FACS

      Affiliations

    • Department of Surgery, Boston Medical Center, Boston, MA

Received 27 November 2008 ,Revised 20 March 2009 ,Accepted 23 March 2009.

References 

  1. Brent GA. Clinical practice (Graves' disease). N Engl J Med. 2008;358:2594–2605
  2. Singer PA, Cooper DS, Levy EG, et al. Treatment guidelines for patients with hyperthyroidism and hypothyroidism (Standards of Care Committee, American Thyroid Association). JAMA. 1995;273:808–812
  3. Baskin HJ, Cobin RH, Duick DS, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract. 2002;8:457–469
  4. Werner SC, Ingbar SH, Braverman LE, et al. Werner & Ingbar's the thyroid: a fundamental and clinical text. 9th ed.. Philadelphia: Lippincott Williams & Wilkins; 2005;
  5. Gold MR. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996;
  6. Muennig P. Designing and conducting cost-effectiveness analysis in medicine and health care. San Francisco: Jossey-Bass; 2002;
  7. Pearce EN. Diagnosis and management of thyrotoxicosis. BMJ. 2006;332:1369–1373
  8. Social Security Administration. Annual statistical supplement period life table 2004. http://www.ssa.gov/OACT/STATS/table4c6.htmlAccessed March 13, 2009
  9. Drug topics red book. Montvale, NJ: Thomson Healthcare; 2007;
  10. US Department of Health and Human Services. Consumer price index (Consumer price index and average annual percent change for all items, selected items, and medical care components Health US 2004). http://www.hhs-stat.net/scripts/topic.cfm?id=73Accessed March 13, 2009
  11. Werner SC, Ingbar SH, Braverman LE, et al. Werner and Ingbar's the thyroid: a fundamental and clinical text. 7th ed.. Philadelphia: Lippincott-Raven; 1996;
  12. Cooper DS. Antithyroid drugs. N Engl J Med. 1984;311:1353–1362
  13. Cooper DS. The side-effects of antithyroid drugs. Endocrinologist. 1999;9:457–476
  14. Tajiri J, Noguchi S. Antithyroid drug-induced agranulocytosis: special reference to normal white blood cell count agranulocytosis. Thyroid. 2004;14:459–462
  15. Cooper DS, Goldminz D, Levin AA, et al. Agranulocytosis associated with antithyroid drugs (Effects of patient age and drug dose). Ann Intern Med. 1983;98:26–29
  16. Rieger R, Pimpl W, Money S, et al. Hyperthyroidism and concurrent thyroid malignancies. Surgery. 1989;106:6–10
  17. Dobyns BM, Sheline GE, Workman JB, et al. Malignant and benign neoplasms of the thyroid in patients treated for hyperthyroidism: a report of the cooperative thyrotoxicosis therapy follow-up study. J Clin Endocrinol Metab. 1974;38:976–998
  18. Phitayakorn R, McHenry CR. Incidental thyroid carcinoma in patients with Graves' disease. Am J Surg. 2008;195:292–297discussion 297
  19. Torring O, Tallstedt L, Wallin G, et al. Graves' hyperthyroidism: treatment with antithyroid drugs, surgery, or radioiodine—a prospective, randomized study (Thyroid Study Group). J Clin Endocrinol Metab. 1996;81:2986–2993
  20. Allannic H, Fauchet R, Orgiazzi J, et al. Antithyroid drugs and Graves' disease: a prospective randomized evaluation of the efficacy of treatment duration. J Clin Endocrinol Metab. 1990;70:675–679
  21. Tamai H, Nakagawa T, Fukino O, et al. Thionamide therapy in Graves' disease: relation of relapse rate to duration of therapy. Ann Intern Med. 1980;92:488–490
  22. Berglund J, Christensen SB, Dymling JF, et al. The incidence of recurrence and hypothyroidism following treatment with antithyroid drugs, surgery or radioiodine in all patients with thyrotoxicosis in Malmo during the period 1970−1974. J Intern Med. 1991;229:435–442
  23. Holm LE, Dahlqvist I, Israelsson A, et al. Malignant thyroid tumors after iodine-131 therapy: a retrospective cohort study. N Engl J Med. 1980;303:188–191
  24. Holm LE, Hall P, Wiklund K, et al. Cancer risk after iodine-131 therapy for hyperthyroidism. J Natl Cancer Inst. 1991;83:1072–1077
  25. Hanson GA, Komorowski RA, Cerletty JM, et al. Thyroid gland morphology in young adults: normal subjects versus those with prior low-dose neck irradiation in childhood. Surgery. 1983;94:984–988
  26. Sawyers JL, Martin CE, Byrd BF, et al. Thyroidectomy for hyperthyroidism. Ann Surg. 1972;175:939–947
  27. Menegaux F, Ruprecht T, Chigot JP. The surgical treatment of Graves' disease. Surg Gynecol Obstet. 1993;176:277–282
  28. Werga-Kjellman P, Zedenius J, Tallstedt L, et al. Surgical treatment of hyperthyroidism: a ten-year experience. Thyroid. 2001;11:187–192
  29. Wood LC, Ingbar SH. Hypothyroidism as a late sequela in patient with Graves' disease treated with antithyroid agents. J Clin Invest. 1979;64:1429–1436
  30. Irvine WJ, Gray RS, Toft AD, et al. Spectrum of thyroid function in patients remaining in remission after antithyroid drug therapy for thyrotoxicosis. Lancet. 1977;2:179–181
  31. Falk SA. Thyroid disease: endocrinology, surgery, nuclear medicine, and radiotherapy. New York: Raven Press; 1990;
  32. Azizi F, Ataie L, Hedayati M, et al. Effect of long-term continuous methimazole treatment of hyperthyroidism: comparison with radioiodine. Eur J Endocrinol. 2005;152:695–701
  33. Weber KJ, Solorzano CC, Lee JK, et al. Thyroidectomy remains an effective treatment option for Graves' disease. Am J Surg. 2006;191:400–405
  34. Palit TK, Miller CC, Miltenburg DM. The efficacy of thyroidectomy for Graves' disease: a meta-analysis. J Surg Res. 2000;90:161–165
  35. Weetman AP. Graves' disease. N Engl J Med. 2000;343:1236–1248
  36. Orgiazzi J. Management of Graves' hyperthyroidism. Endocrinol Metab Clin North Am. 1987;16:365–389
  37. Miller RD, Cucchiara RF. Anesthesia. Philadelphia: Churchill Livingstone; 2000;
  38. Tengs TO, Wallace A. One thousand health-related quality-of-life estimates. Med Care. 2000;38:583–637
  39. Vidal-Trecan GM, Stahl JE, Durand-Zaleski I. Managing toxic thyroid adenoma: a cost-effectiveness analysis. Eur J Endocrinol. 2002;146:283–294
  40. Zanocco K, Angelos P, Sturgeon C. Cost-effectiveness analysis of parathyroidectomy for asymptomatic primary hyperparathyroidism. Surgery. 2006;140:874–881discussion 881−882
  41. Vidal-Trecan GM, Stahl JE, Eckman MH. Radioiodine or surgery for toxic thyroid adenoma: dissecting an important decision (A cost-effectiveness analysis). Thyroid. 2004;14:933–945
  42. Farbota LM, Calandra DB, Lawrence AM, et al. Thyroid carcinoma in Graves' disease. Surgery. 1985;98:1148–1153
  43. Kraimps JL, Bouin-Pineau MH, Mathonnet M, et al. Multicentre study of thyroid nodules in patients with Graves' disease. Br J Surg. 2000;87:1111–1113
  44. Lal G, Ituarte P, Kebebew E, et al. Should total thyroidectomy become the preferred procedure for surgical management of Graves' disease?. Thyroid. 2005;15:569–574
  45. Ku CF, Lo CY, Chan WF, et al. Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves' disease. A N Z J Surg. 2005;75:528–531
  46. Barakate MS, Agarwal G, Reeve TS, et al. Total thyroidectomy is now the preferred option for the surgical management of Graves' disease. A N Z J Surg. 2002;72:321–324
  47. Granter SR, Cibas ES. Cytologic findings in thyroid nodules after 131I treatment of hyperthyroidism. Am J Clin Pathol. 1997;107:20–25
  48. Centeno BA, Szyfelbein WM, Daniels GH, et al. Fine needle aspiration biopsy of the thyroid gland in patients with prior Graves' disease treated with radioactive iodine (Morphologic findings and potential pitfalls). Acta Cytol. 1996;40:1189–1197

 Disclosure Information: Nothing to disclose.

PII: S1072-7515(09)00380-9

doi: 10.1016/j.jamcollsurg.2009.03.025

Journal of the American College of Surgeons
Volume 209, Issue 2 , Pages 170-179.e2 , August 2009

Article Tools

* Image Usage & Resolution