Ablation vs antithyroid drugs vs thyroidectomy in Graves’ disease: A literature review

Backgrounds: Graves' disease (GD) is the most common cause of hyperthyroidism, characterized by autoimmune stimulation of the thyroid gland. Long-term treatment options include antithyroid drugs (ATDs), radioactive iodine (RAI), and thyroidectomy, but there is no universal agreement on which treatment approach is best. Each modality has different benefits and limitations, making comparative evaluation is important to help guide individual treatment decisions.

Methods: This literature review summarizes evidence from clinical trials, meta-analyses, and observational studies evaluating the efficacy, recurrence rates, safety profiles, and long-term outcomes of antithyroid drugs (ATD), RAI, and thyroidectomy in the management of Graves’ disease. Databases such PubMed, SpringerLink, ScienceDirect, and references inside the extracted studies were used.

Results: ATDs remain the preferred first-line therapy in many regions due to their non-invasive approach and potential for remission, although 30–70% of patients relapse after discontinuation. Long-term low-dose therapy can reduce recurrence but requires monitoring for hepatotoxicity. RAI demonstrates high cure rates (>90%) and is cost-effective, but frequently results in permanent hypothyroidism and may worsen orbitopathy. Thyroidectomy provides the most definitive treatment, with a relapse rate about zero and rapid achievement of euthyroidism, although it carries risks such as recurrent laryngeal nerve injury and hypoparathyroidism. Comparative studies consistently show superior remission with surgery, followed by RAI, while ATDs have the highest recurrence.

Conclusions: Each treatment modality for GD offers distinct advantages and disadvantages. Thyroidectomy provides the most reliable cure, RAI offers effective and economical definitive therapy, and ATDs remain valuable first-line options. Optimal treatment selection should be individualized based on patient preference, comorbidities, and desired long-term outcomes.