Table 2.

Advantages and disadvantages of surgery (total thyroidectomy) and RAI

Advantages and Disadvantages of Radio-iodine

Advantages include:

• Simple

• No scar

• No surgical risk

Disadvantages include:

• Best avoided in the young, pre-pubertal child if possible

• Best avoided in large goitres where second dose may be needed

• Need to follow safety guidance post Rx with implications in terms of school, contact with other family members etc

• Risk of crisis (very small)

• Can excacerbate eye disease – glucocorticoid cover may be needed

• Fluctuating thyroid status post administration – can be addressed by a period of BR therapy with ATD stopped after ~ 4 to 6 months

• Potential need for second dose – reduced likelihood if larger dose or (potentially) if dosimetry used

• Must be avoided if there is a risk of pregnancy

• Potential longer term neoplasia risk

Advantages and Disadvantages of surgery (total thyroidectomy)

Advantages include:

• Immediate resolution of hyperthyroidism

• Removes goitre

Disadvantages include:

• Anaesthetic risks

• Well recognised surgical risks eg bleeding

• Scar

• Long term hypoparathyroidism

• Voice change (damage to recurrent laryngeal nerve or superior laryngeal nerve’s external branch)