From: GRADE-ADOLOPMENT of hyperthyroidism treatment guidelines for a Pakistani context
Original Recommendation | Sufficient activity of RAI should be administered in a single application, typically a mean dose of 10–15 mCi (370–555 MBq), to render the patient with GD hypothyroid (Strong Recommendation; Moderate Quality Evidence) | |||
Modified Recommendation | As a substitute for RAI, ATD treatment (with routine thyroid function test monitoring) may be continued or surgery may be performed, to render the patient with GD hypothyroid | |||
Overall Conclusion | ||||
☐Strong recommendation for Modification | ☐Conditional recommendation for Proposed Modification | ☐Conditional recommendation for either Original Recommendation or Proposed Modification | ☐Conditional recommendation for Original Recommendation | ☒Strong recommendation for Original Recommendation |
Additional Suggestions: • If no major financial concerns, RAI therapy is a feasible option as a definitive treatment in patients on high doses of ATDs for GD. • RAI therapy should be preferred over surgical treatment in GD patients not responding to medical treatment. • Patients with uncontrolled GD without orbitopathy, relapsed cases, and those requiring ATD for more than 2 years should also be considered for RAI therapy | ||||
Justification: • Long-term follow up is reduced as once the patient becomes hypothyroid thyroxine dosage usually remains static. • Expertise for ATD calculation is usually lacking in LMICs, with dose calculation increasing patient-borne costs • ATDs result in a longer time taken to achieve euthyroid status and treatment failure rates are higher compared to RAI therapy. • It is easier to manage primary hypothyroidism as opposed to GD, particularly in the case of non-compliance or potentially deadly thyroid storm. • RAI therapy is more cost-effective than surgical treatment and usually leads to definitive cure. |