Management of Graves' disease in Australia

Surveys of physicians in Europe, the USA and elsewhere have shown marked international differences in the management of Graves' disease. There are no comparable data on clinical practice in Australia.

To examine the current management of Graves' disease by Australian endocrinologists, particularly controversial aspects of management.

A questionnaire, modified from previous studies, was sent to members of the Endocrine Society of Australia, asking how they would manage a 43-year-old female with a first episode of Graves' disease. Eight variations on this index case (goitre size, age, sex, severity, recurrent disease) were then introduced. A novel ninth variation, recurrent Graves' disease accompanied by moderate ophthalmopathy, was added.

Responses from 130 endocrinologists who regularly managed Graves' disease in adults were analysed. For the index case, medical treatment with antithyroid drugs was recommended by 81% of respondents and radioiodine by 19%. Most respondents also recommended medical treatment for a patient aged 19 years, a patient with a large goitre, no goitre or severe hyperthyroidism. For an older patient aged 71 years, however, 57% of endocrinologists recommended radioiodine, and the remainder medical treatment. For recurrent Graves' disease after previous medical treatment, 76% of respondents recommended radioiodine, 22% medical treatment and 2% surgery. By contrast, for an identical case accompanied by moderate ophthalmopathy, 54% recommended medical treatment, 27% surgery and only 19% radioiodine.

Most endocrinologists in Australia recommend medical treatment for a first episode of Graves' disease. Radioiodine is used mainly in older patients and for recurrent disease. In the presence of significant ophthalmopathy, most endocrinologists avoid the use of radioiodine.