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The Treatment of Graves Disease

Robert H. Caplan, MD
JAMA. 1974;228(8):976. doi:10.1001/jama.1974.03230330018007.
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To the Editor.—  In their letter (227:939, 1974) on treatment of Graves disease, Caswell and Maier unfortunately overemphasize the deficiencies of radioactive iodine and antithyroid drug therapy and do not adequately discuss the disadvantages of subtotal thyroidectomy. The authors state that patients treated with radioactive iodine frequently require multiple doses, resulting in prolongation of a serious illness. This is not the case, because 80% of patients are rendered euthyroid with one dose of radioactive iodine.1 In addition, antithyroid drugs, iodide, or propranolol— the same medications used to render a patient euthyroid before surgery— may be used prior to or soon after the administration of radioactive iodine in seriously ill patients to achieve euthyroidism as quickly as possible. The authors also imply that radioactive iodine is particularly disadvantageous to women in the childbearing years. Although radioactive iodine is contraindicated during pregnancy, genetic damage to progeny in women previously treated with


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