International differences in approaches to 131I therapy for Graves' disease: case selection and restrictions recommended to patients in Japan, Korea, and China.

Members of the American Thyroid Association (ATA), European Thyroid Association (ETA), Japan Thyroid Association (JTA), Korean Thyroid Association (KTA), and Chinese Thyroid Association (CTA) were surveyed independently through an identical questionnaire on their management of Graves' disease. One of the major purposes of the survey was to determine how expert thyroidologists in different regions of the world use three different therapies available for a typical Graves' patient as well as for clinical variations provided. In this report, we summarized, contrasted, and interpreted the results of the surveys in three Asian countries by focusing on therapeutic preference of radioiodine. For the index patient with hyperthyroidism due to Graves' disease, radioiodine was the therapy of choice for 69% of ATA respondents but only 22%, 22%, 11%, and 11% of ETA, CTA, JTA, and KTA respondents, respectively. The goal of radioiodine therapy in Asian countries was to restore the euthyroid state. For the case of recurrence after surgery, there was consensus on choosing radioiodine among all countries surveyed. To interpret the reluctance to advocate radioiodine therapy for a typical Graves' patient in Japan, a new survey concerning the current trends in radioiodine therapy in Japan was conducted among clinical members of the JTA. The phobia of radiation and stringent safety rules for radioactive pharmaceuticals were the two major reasons found. Nevertheless, the percentage of JTA respondents who aim for the euthyroid of hypothyroid state by radioiodine therapy for typical Graves' significantly increased compared with respondents to the former survey in 1988. Moreover, a considerable number of JTA members believe that more radioiodine therapy should be applied for achievement of the rapid improvement of hyperthyroidism, for convenience, and for medical cost benefits.