TOPLINE:
Surgery and radioactive iodine (RAI) are associated with a lower risk for long-term major adverse cardiovascular events (MACE) than long-term use of antithyroid drugs in patients with newly diagnosed hyperthyroidism.
METHODOLOGY:
- Antithyroid drugs (ATDs) are now the most common treatment for hyperthyroidism, but there is a lack of population-level evidence comparing drugs with RAI or surgery to lower the risk for MACE in patients.
- This study used the Taiwan's National Health Insurance Research Database to compare the long-term risks for MACE among 114,062 patients (mean age, 44.1 years; 73.2% women) with newly diagnosed hyperthyroidism.
- They included patients who received either ATDs alone, RAI, or thyroidectomy within 18 months of diagnosis and were followed up until the development of MACE, death, or the end date of the database.
- The primary outcomes were MACE (a composite of acute myocardial infarction, stroke, heart failure, and cardiovascular mortality) and all-cause mortality.
- Secondary outcomes included individual MACE components and hyperthyroidism relapse.
TAKEAWAY:
- The majority of patients (93.9%) received ATDs as the first-line treatment for hyperthyroidism, while 5.1% had surgery and 1.1% got RAI.
- The risk for long-term MACE was 55% lower in patients treated with RAI than in those treated with ATDs (P = .03).
- Surgery was associated with a 24% lower risk for long-term MACE (P = .04) and a 47% lower risk for all-cause mortality (P < .001) than ATDs.
- The group of patients who received ATDs showed the highest rate of hyperthyroidism relapse (63.5%), followed by those treated with RAI (38.2%) and surgery (17.3%).
IN PRACTICE:
"These findings suggest that surgery or RAI [radioactive iodine] may be better options than long-term ATD [antithyroid drugs] treatment in patients with hyperthyroidism who are at risk of MACE," wrote the authors.
SOURCE:
The study, which was led by Carol Chiung-Hui Peng, MD, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, was published online in JAMA Network Open.
LIMITATIONS:
Relying on International Classification of Diseases codes for hyperthyroidism posed difficulties in distinguishing Graves disease from toxic nodular disease. The study's retrospective cohort design and limited access to medical records restricted the exploration of factors associated with treatment choices. Sparse use of RAI in Taiwan led to a disproportionately small study population, thereby limiting statistical power for certain outcomes.
DISCLOSURES:
This work was supported by grants from Hualien Tzu Chi Hospital and the Buddhist Tzu Chi Medical Foundation in Taiwan. Two of the authors reported receiving personal fees from the National Dairy Council and Merck China, as well as holding membership in the Management Council of the Iodine Global Network and American Thyroid Association's thyroid in pregnancy clinical guidelines task force.