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ORIGINAL ARTICLE
Year : 2009  |  Volume : 6  |  Issue : 3  |  Page : 79-83

Graves' disease: Comparison of treatment effect of three modalities and patient satisfaction


Department of Diabetes and Endocrinology, Manipal Hospital, Bangalore, India

Correspondence Address:
A Bhattacharyya
Department of Diabetes and Endocrinology, Manipal Hospital, Bangalore
India
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Source of Support: None, Conflict of Interest: None


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Graves 'disease treatment includes anti-thyroid medications followed by one of three: medical regimen (Titration or Block & Replacement (B&R), thyroidectomy, Radioactive Iodine (RAI) ablation. Materials and methods: Patients treated for Graves, small or no goitre, one year after completion of definitive therapy constituted this cohort. Age, thyroid hormone levels at diagnosis, sex, goitre size, duration of therapy & follow up and treatment were recorded. Patient satisfaction for treatment was assessed by anonymous in-house questionnaire survey (5point Likert scale). Results: 85 patients constituted this cohort - 42 treated with B&R, eight underwent thyroidectomy, 35 treated with RAI Cumulative follow up after B&Rw as 882 patient-months, 1036 after RAI, 356 after surgery. Eight relapsed (19%) after B&R. Age & thyroid hormone at presentation, sex, goitre size had no bearing on the relapse. 83% of patients treated by RAI developed hypothyroidism compared to 19% by B&R (p<0.001). Fear of relapse significantly higher in the B&R group (p<0.005), fear of side effects was greater in the RAI group (p<0.01). Conclusion: A good course of medical therapy can be tried as the first line of management for patients with Graves ' disease without a big goiter. The chances of becoming hypothyroid & relapse rate are much less with B&R in comparison to other modalities of treatment.


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