[Basedown disease, thyroid gland autonomy, nodular goiter. When is radiotherapy indicated?]

Treatment options for benign diseases of the thyroid include medication, radioiodine therapy and surgery. Patients with hyperthyroidism initially receive antithyroid drugs, with further treatment determined by the relapse risk. In the case of Graves' disease this is determined by a number of risk factors, including the volume of the thyroid gland or the presence of endocrinal ophthalmopathy. In such cases with a high relapse risk, radioiodine therapy is the recommended first-line treatment. Further indications--if surgery is not necessary--are autonomous goiter, recurrent (autonomous) goiter and latent hyperthyroidism. A single radioiodine treatment suffices to control the situation in more than 90% of the cases, and the goiter clearly diminishes in size. Radiation-induced malignancies or malformations have not been seen, but iodine treatment is contraindicated in pregnancy. In view of the short hospital stay of only four to five days, and the ready availability of treatment units, the authors consider radioiodine therapy a suitable first-line option in patients with Graves' hyperthyroidism.