Radioactive Iodine, Antithyroid Drugs, and Surgery in Treatment of Hyperthyroidism

FOR MANY years there has been a difference of opinion between surgeons and internists regarding the treatment of hyperthyroidism. Prior to 1946 various antithyroid drugs provided temporary or partial control of the disease, but the high recurrence rate (50%) and frequent toxic reactions (10%) made the antithyroid drugs unsatisfactory for definite therapy. Thyroidectomy was accepted as the treatment of choice until radioactive iodine (¹³¹I) became readily available. Radioiodine appeared to offer an almost ideal combination of low cost, simplicity of administration, lack of operative risks, and good control of symptoms. These apparent advantages have made¹³¹I the principal mode of treatment of hyperthyroidism for the last 20 years and our medical colleagues have relied upon thyroidectomy as the definitive therapy for a steadily decreasing number of patients. Sufficient time has elapsed to permit evaluation of the long-term results of radioiodine therapy; the findings make imperative a reappraisal of