Date of Award

2022

Document Type

Restricted Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)

Department

Physician Assistant Studies

First Advisor

Eric Van Hecke, MPAS, PA-C, CAQ-EM

Abstract

Background: Graves’ disease is the leading cause of hyperthyroidism in the US. Antithyroid medication, radioactive iodine, and surgery have all demonstrated success in controlling symptoms and reducing complications; however, there is debate about which modality should be considered first-line, if any. Over the last two decades, clinicians have increasingly chosen antithyroid drugs over radioactive iodine despite insufficient evidence that they can successfully induce remission of disease.

Purpose: This analysis aims to determine whether antithyroid drugs are inferior to radioactive iodine at inducing remission of Graves’ disease.

Methods: A comprehensive literature review was conducted using Augsburg University’s Lindell Library, PubMed, Cochrane Library and ScienceDirect databases using the search terms “Antithyroid drugs AND Radioactive iodine,” “Graves’ AND Remission,” “RAI OR radioactive iodine OR methimazole OR antithyroid drugs AND Remission.” Other terms were searched to draw conclusions about remission, including “Relapse,” “Treatment AND success OR failure,” and “Euthyroid state”. The research was conducted to find peer-reviewed studies that assessed both treatments’ ability to induce remission.

Conclusions: Many studies have shown that radioactive iodine can effectively induce remission of Graves’ disease. Trials that have been conducted on antithyroid drugs, however, are insufficient in answering the research question. Individual patient factors, like age, goiter size, antibody levels, etc., need to be assessed before making definitive conclusions. With the current body of evidence, it is best practice that clinicians continue to use stratification tools, like the GREAT score, to determine treatment plans for each patient until further research has been conducted.

Identifier

SC 11.PAS.2022.Altman.L

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