Abstract
Introduction
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.
Methods
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.
Results
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.
Conclusions
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.
Keywords
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Article info
Publication history
Published online: November 21, 2022
Accepted:
October 18,
2022
Received in revised form:
October 3,
2022
Received:
July 24,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.
