BACKGROUND
Graves’ disease is an autoimmune condition in which the body produces antibodies that mimic TSH, attacking the thyroid and causing it to secrete high levels of thyroid hormone to produce hyperthyroidism. Graves’ disease is the most common type of hyperthyroidism in the United States. Several options to treat Graves’ disease exist, including long term treatment with antithyroid medications, surgery to remove the thyroid and radioactive iodine therapy to destroy the thyroid. Recently, a technique known as radiofrequency ablation (RFA) has been used to treat hyperthyroidism in recurrent Graves’ disease. RFA uses ultrasound to insert a very thin needle into a thyroid nodule then uses heat to destroy the nodule. RFA avoids both the risks and scarring associated with surgery and permanent hypothyroidism following both surgery and radioactive iodine treatment. Some studies suggest that RFA treatment may be associated with a better quality of life.

In this study, the researchers evaluated the quality of life of Graves’ disease patients after treatment with surgery, radioactive iodine therapy or RFA.

THE FULL ARTICLE TITLE
Fung MHM, et al. Comparing the health-related quality of life at two years after successful treatment of relapsed Graves’ disease with radiofrequency ablation, surgery, or radioiodine. World J Surg 49(11), 3142-3151; doi: 10.1002/wjs.70035. PMID: 40874814

SUMMARY OF THE STUDY
The study recruited patients from a single endocrine surgical unit in China from 2020 to 2022 who had persistent or recurrent Graves’ disease and were treated with RFA, surgery, or radioactive iodine therapy. Patients were not included in the study if they had moderate to severe Graves’ eye disease.

All patients were given a series of health-related quality of life (HRQOL) questionnaires to complete at 2 years following their treatment. A total of 85 patients participated by completing these questionnaires. They completed both thyroid specific and general HRQOL questionnaires. Questionnaire results from a subset of patients (45, 15 per group) matched for gender, age, thyroid function and other medical problems were analyzed.

The average age was 34 years, and the majority of patients were female (91%). All patients that were treated with surgery and radioactive iodine therapy became hypothyroid and required thyroid hormone replacement. However, thyroid hormone replacement was only required in 13% of RFA patients. Results demonstrated that patients in the RFA group had significantly better scores for depression symptoms on the thyroid specific HRQOL survey compared to patients who received either surgery or radioactive iodine therapy. The RFA group also demonstrated a trend toward better scores for anxiety, hypothyroid symptoms, and fatigue on the thyroid specific HRQOL questionnaire. There were no significant differences between the treatment options on any of the general HRQOL questionnaires.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
RFA is a viable alternative method for treatment of recurrent Graves’ disease when compared to surgery or radioactive iodine therapy. Overall, at 2 years, most quality-of-life measurements were comparable between therapies except for less depression symptoms noted in patients who received RFA. Ongoing research is desired to confirm and extend these findings to a larger population.

—Whitney W. Woodmansee MD

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