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February 25, 1974

The Treatment of Graves Disease

Author Affiliations

Temple University Medical School and Hospital Philadelphia

JAMA. 1974;227(8):939-940. doi:10.1001/jama.1974.03230210049016

To the Editor.—  The widespread use of radioactive iodine as a definitive treatment of Graves disease began approximately in 1950. Initial reports of excellent results with this agent and its ability to be used on outpatients casued it to be the preferred treatment, and it appeared to eliminate surgery in this disease.In the same era, the long-term use of antithyroid drugs, in an effort to obtain permanent remission, was reported and recommended. Subsequently, evaluation of these two methods of treatment has revealed serious deficiencies.Those patients treated with radioactive iodine frequently required multiple doses of the drug, resulting in prolongation of a serious illness, which was particularly disadvantageous in women in the childbearing time of their lives. It also became apparent that successful treatment with radioactive iodine was accompanied by a high incidence of hypothyroidism (45% to 70%), requiring lifetime thyroid replacement.1 Attempts to use a lower dose