BACKGROUND
Hyperthyroidism is a condition of increased thyroid hormone production by the thyroid gland. Symptoms include fast heart rate, heat intolerance, weight loss, insomnia, anxiety and tremors. The most common cause of hyperthyroidism is Graves’ disease, where an antibody attacks and turns on the thyroid; followed by toxic nodular goiter, where the cells in a thyroid nodules start working on their own and do not shut down when thyroid levels increase. There are 3 treatment options for hyperthyroidism – antithyroid drugs (ATD) with either methimazole or propylthiouracil, radioactive iodine therapy (RAI) and thyroid surgery (thyroidectomy). There are various factors that go into deciding which treatment option to consider, including the underlying cause for hyperthyroidism, side effects of treatment and patient preferences.

This study aimed to assess the long-term safety of each of the three options of treatment for hyperthyroidism.

THE FULL ARTICLE TITLE
Chiung-Hui Peng C et al. Mortality risks associated with antithyroid drugs, radioactive iodine, and surgery for hyperthyroidism: a systematic review and network meta-analysis. Thyroid. 2025 Sep 1; doi: 10.1177/10507256251372193. PMID: 40891035.

SUMMARY OF THE STUDY
The study evaluated many published studies that compared long term outcomes in patients with hyperthyroidism who were treated with ATDs, RAI or surgery. The analysis included 12 studies with a total of 192,208 patients from Europe, North America, Asia and the Middle East.

The all-cause death rate in hyperthyroid patients was lower when comparing surgery to ATDs and when comparing surgery to RAI. Death due heart disease was lower when comparing surgery to ATDs and when comparing surgery to RAI. There was no significant difference in major adverse heart events (ie. heat attack, stroke and death due to heart disease) or death due to cancer among surgery, ATDs and RAI.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study found that patients with hyperthyroidism who underwent thyroid surgery had a lower all-cause risk of death and heart problems compared to ATDs and RAI. The reason this was the case is a bit unclear. It is possible that achieving better and more rapid control of thyroid hormone levels with surgery may contribute to the results seen. However, the studies included in the analysis do not take into account the baseline health status and other factors in the individual treatment groups that could result in better outcomes in patient undergoing surgery. The study also does not consistently differentiate between the different types of hyperthyroidism which is important when interpreting the results.

Further studies are required to understand the long-term outcomes of various treatment options available for the management of hyperthyroidism.

— Poorani Goundan, MD

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