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Variation in the use of definitive treatment options in the management of Graves' disease: a UK clinician survey
  1. Jessica Hookham1,
  2. Emma E Collins2,
  3. Amit Allahabadia3,
  4. Sabapathy P Balasubramanian2
  1. 1Medical School, University of Sheffield, Sheffield, UK
  2. 2Department of Endocrine Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  3. 3Department of Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Emma E Collins, Department of Endocrine Surgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Glossop Road, Sheffield S10 2JF, UK; emmacollins100{at}


Background Graves' disease can be treated with antithyroid drugs (ATDs), radioiodine or surgery. Use of definitive treatments (radioiodine or surgery) varies widely across centres. Specific clinical circumstances, local facilities, patient and clinician preferences and perceptions will affect the choice of treatment. Detailed understanding of UK clinicians' views and their rationale for different treatments is lacking.

Aims To study the preferences and perceptions of UK clinicians on the role of surgery and radioiodine in the management of Graves' disease.

Methods ‘British Thyroid Association’ (BTA), ‘Society for Endocrinology’ (SFE) and ‘British Association of Endocrine and Thyroid Surgeons’ (BAETS) members were invited to complete an online survey examining their management decisions in Graves' disease and factors that influenced their decisions.

Results 158 responses from UK consultants were included. The ratio of physicians to surgeons was 11:5 and males to females was 12:4. Most clinicians would commence ATDs in uncomplicated first presentation of Graves' disease. A wide range of risk estimates on the effectiveness and risks of treatment was given by clinicians. Radioiodine was used most frequently in relapsed Graves' disease. However, severe eye disease and pregnancy strongly influenced choice in favour of surgery. Surgeons underestimated the success of radioiodine (p<0.01) and were more likely to recommend thyroidectomy than physicians.

Conclusions This survey demonstrates significant variation in clinicians' perceptions of risks of treatment and their choice of management options for relapsed Graves' disease. The variation appeared to be dependent on patient and disease-specific factors as well as physician experience, gender and specialty.


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