What are the treatment options for Graves’ hyperthyroidism? What are the advantages and disadvantages of each?

There are three main treatments for hyperthyroidism in Graves’ disease, including medical antithyroid drug (ATD) treatment, 131 iodine treatment, and surgical treatment.ATD treatment is relatively mild, and the dosage can be adjusted in time during treatment. The disadvantages are that the treatment duration is long, usually requiring standardized treatment for 1-2 years; during the treatment period, ATD can cause damage to liver function and hematopoietic system; discontinuation of ATD treatment or reduction of dosage is easy for hyperthyroidism to recur, and it has been reported that the recurrence rate of ATD treatment is 40%-60%. Gao Yongju, Department of Nuclear Medicine, Henan Provincial People’s Hospital, said that 131 iodine treatment is simple, but the shortcoming is that it is slow to relieve the symptoms, and the symptoms of hyperthyroidism usually begin to improve about 4 weeks after treatment. 131 iodine treatment does not cause allergic reactions; it does not cause damage to liver function and hematopoietic system, and therefore it is suitable for those who are due to the treatment of ATD caused by abnormalities in liver function or the white bar reduction in the treatment of hyperthyroidism. Some patients with no significant change in symptoms or incomplete relief after six months of 131 iodine therapy can be retreated with 131 iodine therapy.A major regression of 131 iodine therapy is hypothyroidism in a small percentage of patients, which can be treated with simple daily thyroid hormone replacement. Surgery can relieve hyperthyroidism rapidly, especially for patients with obvious enlargement of the thyroid gland and hyperthyroidism accompanied by nodules, but its shortcoming is that it is traumatizing; in some cases, it may result in laryngeal recurrent nerve damage, hypoparathyroidism and other surgical complications. Some patients still have recurrence of hyperthyroidism or hypothyroidism after surgery.