We Moved!
In January of 2010 we will be relocating our practice to our new offices at Grindstone Parkway. All of our services including Columbia Bariatrics, The Vein Center, and our angio suite will continue. Our phone numbers will remain the same. Our new address is:
3220 Bluff Creek Drive, Suite 100. Columbia, MO
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Grave’s Disease: Thyroidectomy Most Cost Effective Treatment Strategy in Medication Resistant Patients.
The first line treatment of Grave’s Disease in the US is a 12-18 month course of anti-thyroidal medications. This treatment will fail in approximately 50% of patients, who will either have resistant or recurrent disease. Repeated treatments of anti-thyroidal medications have a poor success rate, and long term administration is associated with agranulocytosis and hepatotoxicity. Radioactive ablation is a very common treatment in the US, but has a high failure rate at 6.5-18%. Further, improvements of radioactive ablation may take 4 months or longer to occur.
Total thyroidectomy is 100% effective for treatment of Grave’s thyroiditis, and has a halts progression of opthalmopathy in two-thirds of patients, unlike radioactive ablation that may actually worsen opthalmopathy. Moreover, the incidence of thyroid carcinoma in Grave’s disease is increasing to nearly 4% of Grave’s patients, and radioactive ablation significantly complicates appropriate identification of carcinoma.
Thyroidectomy is the only option that treats the carcinoma, and is the only option appropriate for Grave’s patients with a dominant nodule or multi-nodular goiter. Moreover, thyroidectomy is recommended for pregnant patients, younger patients, or pa-tients with a history of neck irradiation.
Thyroidectomy is safe with a 0.2% permanent laryngeal nerve palsy, 0.3% permanent hypocalcemia, and a nearly 0% mortality rate. A 2009 analysis of the cost effectiveness of total thyroidectomy versus radioactive ablation showed that thyroidectomy is superior to radioactive ablation in patients who recurred or were resistant to anti-thyroidal medications. Thyroidectomy showed an incremental cost-effectiveness ratio of $7,250/QALY [Quality Adjusted Life Years] compared to radioactive ablation and $15,697 over anti-thyroidal medications.
Thyroidectomy is a safe and effective treatment for Grave’s disease and should be considered as possible first line treatment in patients who fail initial anti-thyroid medications.
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