BACKGROUND: Definitive treatment of Graves' disease includes radioactive iodine (RAI) and thyroidectomy, but utilization varies. We hypothesize that, in addition to clinical reasons, there are socioeconomic factors that influence whether a patient undergoes thyroidectomy or RAI. METHODS: Patients treated for Graves' disease between August 2007 and September 2013 at our university hospital were included. A comparative analysis of clinical and socioeconomic factors was completed. RESULTS: Of 427 patients, 300 (70 %) underwent RAI, whereas 127 (30 %) underwent surgery. Multiple factors were associated with surgery: younger age (mean 36 vs. 41 years, p < 0.01), female gender (33 vs. 19 % males, p = 0.01), black race (56 vs. 28 % nonblack, p < 0.01), Medicaid or uninsured (43 vs. 27 % private insurance or Medicare, p < 0.01), ophthalmopathy (38 vs. 26 %, p < 0.01), goiter (35 vs. 23 %, p < 0.01), and lowest quartile of median household income (38 vs. 27 % upper three quartiles, p = 0.03). Thyroidectomy increased annually, with 52 % undergoing surgery during the final year (p < 0.01). Adjusting for confounding, younger age (odds ratio [OR] 1.04; 95 % confidence interval [CI] 1.02, 1.05), female gender (OR 2.06; 95 % CI 1.06, 4.01), ophthalmopathy (OR 2.35; 95 % CI 1.40, 3.96), and later year of treatment (OR 1.66; 95 % CI 1.41, 1.95) remained significantly associated with surgery. CONCLUSIONS: Surgery has now become the primary treatment modality of choice for Graves' disease at our institution. Clinical factors are the main drivers behind treatment choice, but patients with lower SES are more likely to have clinical features best treated with surgery, underlying the importance of improving access to quality surgical care for all patients.
BACKGROUND: Definitive treatment of Graves' disease includes radioactive iodine (RAI) and thyroidectomy, but utilization varies. We hypothesize that, in addition to clinical reasons, there are socioeconomic factors that influence whether a patient undergoes thyroidectomy or RAI. METHODS:Patients treated for Graves' disease between August 2007 and September 2013 at our university hospital were included. A comparative analysis of clinical and socioeconomic factors was completed. RESULTS: Of 427 patients, 300 (70 %) underwent RAI, whereas 127 (30 %) underwent surgery. Multiple factors were associated with surgery: younger age (mean 36 vs. 41 years, p < 0.01), female gender (33 vs. 19 % males, p = 0.01), black race (56 vs. 28 % nonblack, p < 0.01), Medicaid or uninsured (43 vs. 27 % private insurance or Medicare, p < 0.01), ophthalmopathy (38 vs. 26 %, p < 0.01), goiter (35 vs. 23 %, p < 0.01), and lowest quartile of median household income (38 vs. 27 % upper three quartiles, p = 0.03). Thyroidectomy increased annually, with 52 % undergoing surgery during the final year (p < 0.01). Adjusting for confounding, younger age (odds ratio [OR] 1.04; 95 % confidence interval [CI] 1.02, 1.05), female gender (OR 2.06; 95 % CI 1.06, 4.01), ophthalmopathy (OR 2.35; 95 % CI 1.40, 3.96), and later year of treatment (OR 1.66; 95 % CI 1.41, 1.95) remained significantly associated with surgery. CONCLUSIONS: Surgery has now become the primary treatment modality of choice for Graves' disease at our institution. Clinical factors are the main drivers behind treatment choice, but patients with lower SES are more likely to have clinical features best treated with surgery, underlying the importance of improving access to quality surgical care for all patients.
Authors: Salem I Noureldine; Ali Abbas; Ralph P Tufano; Sudesh Srivastav; Douglas P Slakey; Paul Friedlander; Emad Kandil Journal: Ann Surg Oncol Date: 2014-03-17 Impact factor: 5.344
Authors: Rebecca S Bahn; Henry B Burch; David S Cooper; Jeffrey R Garber; M Carol Greenlee; Irwin Klein; Peter Laurberg; I Ross McDougall; Victor M Montori; Scott A Rivkees; Douglas S Ross; Julie Ann Sosa; Marius N Stan Journal: Endocr Pract Date: 2011 May-Jun Impact factor: 3.443
Authors: Vishnu Sundaresh; Juan P Brito; Zhen Wang; Larry J Prokop; Marius N Stan; Mohammad H Murad; Rebecca S Bahn Journal: J Clin Endocrinol Metab Date: 2013-07-03 Impact factor: 5.958
Authors: Vincent T Wu; Allison W Lorenzen; Anna C Beck; Vincent J Reid; Sonia L Sugg; James R Howe; Janet H Pollard; Geeta Lal; Ronald J Weigel Journal: Surgery Date: 2016-11-15 Impact factor: 3.982
Authors: Reese W Randle; Maria F Bates; Kristin L Long; Susan C Pitt; David F Schneider; Rebecca S Sippel Journal: Surgery Date: 2017-11-03 Impact factor: 3.982
Authors: Dawn M Elfenbein; Sarah Schaefer; Cynthia Shumway; Herbert Chen; Rebecca S Sippel; David F Schneider Journal: J Am Coll Surg Date: 2015-10-21 Impact factor: 6.113