Cardiovascular Health by Graves’ Disease Management Modality – Surgery Versus Radioactive Iodine Versus Antithyroid Medications: A Network Meta-Analysis

• Published in: The Journal of surgical research 2023-03, Vol.283, p.266-273
• Main Authors: Issa, Peter P., Hussein, Mohammad, Omar, Mahmoud, Munshi, Ruhul, Attia, Abdallah S., Buti, Yusef, Aboueisha, Mohamed, Shama, Mohamed, Toraih, Eman, Kandil, Emad
• Format: Article
• Language: English
• Subjects: Adult; Antithyroid Agents - therapeutic use; Antithyroid medications; Disease Management; Female; Graves Disease - surgery; Graves' disease; Humans; Hypertension; Iodine - therapeutic use; Iodine Radioisotopes - therapeutic use; Male; Meta-analysis; Network Meta-Analysis; Radioactive iodine ablation; Thyroid Neoplasms - surgery; Thyroidectomy
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2022.10.043

Graves' disease is an autoimmune disorder of the thyroid gland associated with the overproduction of thyroid hormones. Excess secretion of thyroid hormones leads to cardiovascular consequences. Treatment options include antithyroid medications (ATM), radioactive iodine (RAI) ablation, and total thyroidectomy. We examined the cardiovascular outcomes following Graves’ disease management modality. A systematic search was performed up to September 22nd, 2021, using PubMed, EMBASE, and Web of Science databases. We conducted a network meta-analysis analyzing cardiovascular outcomes of interest, including congestive heart failure (CHF), arrhythmia, atrial fibrillation (AF), and hypertension. Three studies were included in this analysis totaling 6700 patients with Graves’ disease, of which 74% were female. The mean age was 44.34 y. When compared to pretreatment, management options lowered the risk of maintaining arrhythmia 81% with surgery (relative risk [RR] = 0.19; 95% confidence interval [CI] = 0.12 to 0.31), 67% with ATM (RR = 0.33; 95% CI = 0.23 to 0.49), and 50% with RAI (RR = 0.50; 95% CI = 0.13 to 1.95). Risk of maintaining CHF was reduced 80% with surgery (RR = 0.20; 95% CI = 0.08 to 0.49), 41% with ATM (RR = 0.59; 95%CI = 0.52 to 0.67), and only 7% with RAI (RR = 0.93; 95%CI = 0.68 to 1.26). Treatment-ranking analysis found all parameters, including CHF, arrhythmia, AF, and hypertension, to be in favor of surgical treatment over medical treatment and RAI ablation. This is the first network meta-analysis analyzing the cardiovascular outcomes in Graves’ disease patients by treatment option. Our study demonstrated that surgery is superior to RAI and medical treatment.