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Journal of Thyroid Research
Volume 2016, Article ID 9697849, 6 pages
http://dx.doi.org/10.1155/2016/9697849
Research Article

Change in Practice over Four Decades in the Management of Graves’ Disease in Scotland

1Department of Surgery, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK
2University Department of Surgery, Faculty of Medicine, University of Glasgow, Royal Infirmary, Glasgow G31 2ER, UK
3School of Medicine, Guy’s King’s & St. Thomas’ Hospitals, King’s College London, London SE1 1UL, UK
4Academic Surgical Unit, Blizard Institute, National Centre for Bowel Research & Surgical Innovation, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London E1 1BB, UK

Received 7 December 2015; Revised 27 March 2016; Accepted 12 April 2016

Academic Editor: Julie A. Sosa

Copyright © 2016 D. M. Smith et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

There is continuing debate on the optimal treatment for Grave’s thyrotoxicosis with a resultant variation in clinical practice. The present study aimed to ascertain changes in practice in the treatment of Grave’s thyrotoxicosis in Tayside, Scotland, over the past four decades. Methods. The “Scottish automated follow-up register” (SAFUR) was queried to identify all patients treated for Grave’s thyrotoxicosis from 1968 to 2007 inclusive. Patients were divided into 4 groups (Groups A to D) according to the decades. Demographic profile, treatment modalities, radioactive iodine (RAI) dose, and recurrence rates were studied and outcomes were compared by test and ANOVA using SPSS v15.0. A value of < 0.05 was considered significant. Results. Altogether, 3737 patients were diagnosed with Grave’s thyrotoxicosis over the 4 decades. Use of RAI has increased from 43.1% in Group A to 68% in Group D (). The dose of RAI has increased () and there has been a reduction in recurrence rate with higher dose of RAI. Surgical intervention rates decreased from 55.3% to 12.3% () over time. Conclusions. Analysis of a large dataset of patients with Grave’s thyrotoxicosis suggests increasing use of RAI as the preferred first line of treatment. Furthermore, using a single higher dose of RAI and adoption of total thyroidectomy have decreased recurrence rates.