Q. My son has Graves' disease. Which is the better treatment option, surgery or radio-iodine?

Answered by
Dr. Minal Mohit Vohra
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 12, 2019

Hello doctor,

My son is 19 years old and has been diagnosed with Graves' disease. He had it for nine months. He is now on 2.5 mg of Methimazole and his TSH, T3, T4 are stable. I know the disease never goes away but he is a college athlete and we need his energy back and more stable environment health-wise. One endocrinologist was saying surgery because he is an athlete and the other says radio-iodine. Not sure with sports which one is better. Please let me know which one works better for Graves'?

My worries on radio-iodine are, infertility? He is only 19 years old, will it cause other cancers? Will he go bald or teeth get damaged? How much radio will he need? How often do people need two rounds?

With surgery, he does not want a scar. But I am concerned about having hyperthyroidism after. What would you do surgery or radio-iodine? Please answer my concerns about both procedures.



Welcome to icliniq.com.

I would suggest radio ablation is the better option if he is a non-smoker, if he has no eye signs, and if the gland is not very large.

As far as your worries are concerned,

1. Fertility is no question. Yes, we suggest avoiding a baby for six months, but your son is too young to father a child.

2. Radio iodine is very specific for thyroid, so no other organ is affected.

3. Again baldness and teeth are not affected as it is not radiation therapy. It is in the form of a tablet and gets absorbed in the thyroid gland.

4. Radio ablation dose will be judged by his thyroid activity and thyroid weight. It will be around 10 millicuries.

5. In case of recurrence, or very active gland, or underdosing there can be a failure requiring repeat dosing.

Surgery is not recommended until the gland is big enough to cause compression of the trachea or esophagus causing difficulty in breathing or swallowing of food.

Thank you doctor,

He plays baseball. How long after the iodine administration can he go back to exercise? Also, he has a dry eye thus so far. How do we know if he has TED for sure?



Welcome back to icliniq.com.

He can play on the same day. As I told you earlier as well, it is just a tablet and it takes only five minutes to be swallowed. Dry gritty eyes can be due to hyperthyroid state and will improve with radio ablation.

I do not know what you mean by TED?

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