Variation in the use of definitive treatment options in the management of Graves' disease: a UK clinician survey

Background: Graves’ disease can be treated with antithyroid drugs (ATDs), radioiodine or surgery. Use of definitive treatments (radioiodine or surgery) varies widely across centres. Specific clinical circumstances, local facilities, patient and clinician preferences and perceptions will affect choice of treatment. Detailed understanding of UK clinicians’ views and their rationale for different treatments is lacking. Aims: To study the preferences and perceptions of UK clinicians on the role of surgery and radioiodine in the management of Graves’ disease. Methods: British Thyroid Association’ (BTA), ‘Society for Endocrinology’ (SFE) and ‘British Association of Endocrine and Thyroid Surgeons’ (BAETS) members were invited to complete an online survey examining their management decisions in Graves’ disease and factors that influenced their decisions. Results: 158 responses from UK consultants were included. The ratio of physicians to surgeons was 11:5 and males to females was 12:4. Most clinicians would commence ATDs in uncomplicated first presentation of Graves’ disease. A wide range of risk estimates on the effectiveness and risks of treatment was given by clinicians. Radioiodine was used most frequently in relapsed Graves’ disease. However severe eye disease and pregnancy strongly influenced choice in favour of surgery. Surgeons underestimated the success of radioiodine (P<0.01) and were more likely to recommend thyroidectomy than physicians. Conclusions: This survey demonstrates significant variation in clinicians’ perceptions of risks of treatment and their choice of management options for relapsed Graves’ disease. The variation appeared to be dependent on patient and disease specific factors as well as physician experience, gender and speciality.