Evaluation of the clinical results of thyroidectomy and RAI treatment in the permanent treatment of Graves' disease

<b>Introduction:</b> Graves' disease (GD) is characterized by the presence of circulating TSH receptor antibodies (TRAb) in the blood and is currently the most common cause of hyperthyroidism. The most common extrathyroidal symptom of GD is Graves' ophthalmopathy (GO). Approximately 20-25% of patients with GD have clinically significant GO, whereas only 5% have moderate to severe one. The pathogenesis of GD and GO is related to each other, and the course of GO influences the choice of treatment modality.<b>Aim:</b> We compared the effects of radioactive iodine (RAI) and surgical treatment modalities used in the definitive treatment of patients with GD who have symptoms of the disease and GO.<b>Materials and methods:</b> Between January 2015 and December 2020, 119 patients who underwent definitive treatment for GD were identified, and those with GO symptoms had eye examinations before and after treatment. Demographic, clinical, pathological, and outcome data were collected from the hospital computer database.<b>Results:</b> Patients in the RAI group were older than the surgical group (49.6 and 41.8, p = 0.005). There was a significant difference between the two groups in the presence of GO (surgical 75.4% RAI 32.6%, p = 0.0001). After the first dose of RAI, 69.5% of the patients had remission. The overall remission rate after additional RAI was 95.6%. Total thyroidectomy was performed in all of the patients in the surgical group. GO was remarkable with a rate of 42.1% among the surgical treatment indications. Ocular symptoms were evaluated with CAS, disease severity, and proptosis. After definitive treatment, GO progression was observed at a rate of 21.8% (n = 10) in the RAI group and 8.8% (n = 5) in the surgical group.<b>Conclusions:</b> The surgical treatment in GD had a higher success rate compared to RAI treatment in cases with active GO. Surgery should be considered the primary and definitive treatment in patients with active GO. At the same time, Clinical Activity Score (CAS) was found to be more valuable than other parameters in the evaluation of treatment response in both groups.