Treatment of Graves' hyperthyroidism

Therapy	Advantages	Disadvantages
Thionamides	Chance of permanent remission Some patients avoid permanent hypothyroidism Lower initial cost	Minor side effects – Rash, hives, arthralgias, transient granulocytopenia, gastrointestinal symptoms Major side effects – Agranulocytosis, vasculitis (lupus-like syndrome), hepatitis Risk of fetal goiter, hypothyroidism, and congenital anomalies if pregnant Requires more frequent monitoring
Radioiodine	Permanent resolution of hyperthyroidism	Permanent hypothyroidism Patient must take radiation precautions for several days after treatment, avoiding contact with young children and pregnant women Development or worsening of Graves' ophthalmopathy Rare radiation thyroiditis Patient concerns about long-term oncogenic effects of radiation
Surgery	Rapid, permanent cure of hyperthyroidism	Permanent hypothyroidism Risks for iatrogenic hypoparathyroidism and recurrent laryngeal nerve damage Risks associated with general anesthesia High cost

Summary of the advantages and disadvantages of the 3 major therapeutic modalities used in the treatment of Graves' hyperthyroidism.

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