Machfud Fauzi, Jongky Hendro Prajitno, Gwenny Ichsan Prabowo, Hermina Novida

Effectiveness of Radioiodine Therapy for Graves' Hyperthyroidism: A Quality-of-Life Assessment

Introduction

Effectiveness of radioiodine therapy for graves' hyperthyroidism: a quality-of-life assessment. Systematic review on radioiodine therapy for Graves' hyperthyroidism. Discover its effectiveness in improving patients' quality of life across physical, psychological, and social aspects.

Abstract

Introduction: Graves' disease, an autoimmune disorder characterized by hyperthyroidism, is commonly managed through radioactive iodine therapy, antithyroid drugs, and thyroidectomy. Previous reports suggest that individuals undergoing radioactive iodine therapy exhibit superior overall quality of life and satisfaction compared to those opting for alternative therapeutic modalities. This study systematically reviewed evidence on the effectiveness of radioiodine therapy for Graves' hyperthyroidism, specifically emphasizing its impact on patients' quality of life. Methods: A systematic review was conducted on studies evaluating the quality of life of adult patients with Graves’ hyperthyroidism following radioiodine therapy. A literature search was carried out utilizing the PubMed, ScienceDirect, and Sage Journals online databases. The search results were screened according to the eligibility criteria for inclusion in a narrative synthesis. Results: The search yielded 203 items, of which four articles fulfilled the eligibility criteria and were included in the review. radioiodine therapy demonstrated improvements in the quality of life of patients with Graves' disease compared to other therapeutic modalities or no treatment at all. Enhancement in quality of life was observed across various scales, encompassing physical symptoms (goiter, hyperthyroidism, eye symptoms, and hypothyroidism), psychological symptoms (depression and anxiety), functioning and well-being (fatigue, cognitive impairment, and emotional vulnerability), and participation (social life disruptions, daily life interference, and cosmetic complaints). Conclusion: Findings concerning quality of life underscore the long-term effectiveness of radioiodine therapy as a preferred intervention for Graves' disease, contributing valuable insights for clinical decision-making. Highlights: 1. This systematic review comprehensively synthesizes research findings regarding the impact of radioiodine therapy on the long-term quality of life of patients with Graves’ hyperthyroidism compared to surgery or antithyroid medication. 2. The findings suggest that radioiodine therapy offers improvement in the quality of life, which may be indicated by physical and psychological symptoms, functioning, well-being, and participation.

Review

This systematic review addresses a clinically pertinent question regarding the effectiveness of radioiodine therapy for Graves' hyperthyroidism, specifically focusing on its impact on patients' quality of life (QoL). The choice to concentrate on QoL is commendable, as it moves beyond purely biochemical outcomes to encompass the patient's lived experience, a crucial aspect of patient-centered care. The systematic methodology, including a literature search across major databases, is appropriate for synthesizing existing evidence on this important topic, aiming to provide valuable insights for treatment selection in Graves' disease management. The review identified that radioiodine therapy led to improvements in QoL across a comprehensive range of scales, covering physical, psychological, functional, and participatory aspects. This finding robustly supports the long-term benefits of this therapeutic modality. However, a significant observation is the inclusion of only four articles out of an initial yield of 203. While the abstract mentions "eligibility criteria," this remarkably low conversion rate from initial search to final inclusion suggests a considerable paucity of high-quality, directly relevant QoL studies in this specific area, or potentially very stringent inclusion criteria were applied. This limitation restricts the breadth of evidence synthesized and underscores the need for more primary research explicitly designed to assess QoL following radioiodine therapy. The narrative synthesis, rather than a quantitative meta-analysis, is understandable given the likely heterogeneity and low number of included studies. In conclusion, the findings of this systematic review affirm radioiodine therapy as an effective intervention for Graves' hyperthyroidism, particularly highlighting its positive long-term impact on patients' quality of life. This evidence is valuable for informing clinical decision-making and patient counseling, advocating for radioiodine as a preferred option where appropriate. Moving forward, future research should prioritize conducting larger, well-designed primary studies that specifically evaluate the long-term QoL outcomes of radioiodine therapy, ideally with direct comparisons to other treatments using standardized and validated QoL instruments. This would further strengthen the evidence base and allow for more robust quantitative syntheses.

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