Radioiodine or Surgery for Toxic Thyroid Adenoma: Dissecting an Important Decision. A Cost-Effectiveness Analysis
Abstract
OBJECTIVE: To examine the cost effectiveness of therapeutic strategies for toxic thyroid adenoma. DESIGN: Markov state transition decision analytic model. SETTING: Ambulatory and inpatient. PATIENTS: Hypothetical cohort of 40- year-old women with toxic thyroid adenomas. Patient age was varied in sensitivity analyses. Data on the prevalence of coincident thyroid cancer, complications, and treatment efficacies were derived from a systematic review of the literature. INTERVENTIONS: Thyroid lobectomy after a 3 month-course of antithyroid drugs (ATDs), high-dose (<555 MBq) radioactive iodine (RAI), low-dose (>555 MBq) RAI, and lifelong ATDs. MEASUREMENTS AND MAIN RESULTS: Outcomes were measured in quality-adjusted life years (QALYs). Costs were estimated from the health care system perspective. Future costs and effectiveness were discounted at 3% per year. For a 40- year-old woman, surgery was the most effective, while low-dose RAI was the least costly. The marginal cost-effectiveness of surgery versus low-dose RAI was $13,183 per QALY. Surgery was less costly and more effective than lifelong ATDs. RAI was more effective than surgery if surgical mortality exceeded 0.90% (base-case 0.001%). Surgery provided relatively inexpensive gains (<$50,000 per QALY) in quality-adjusted life expectancy in patients less than 74 years of age. CONCLUSIONS: For most patients less than 60 years of age, surgery is an effective strategy with a reasonable cost. However, for any given patient, surgical mortality, therapeutic costs and preference must be considered in choosing an appropriate therapy.
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There is concern for thyroid malignancy following RAI therapy.
“Following RAI therapy, there have been reports of new-onset GD (up to 4% prevalence) (263) as well as concern for thyroid malignancy (254,264,265) and a very minimal increase in late nonthyroid malignancy (265).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [254]
A small risk of permanent RLN injury exists with surgery for TA.
“A small risk of permanent RLN injury exists with surgery for TA (254).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [254]
For patients with TA, the risk of treatment failure is <1% after surgical resection (ipsilateral thyroid lobectomy or isthmusectomy).
“For patients with TA, the risk of treatment failure is <1% after surgical resection (ipsilateral thyroid lobectomy or isthmusectomy) (254).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [254]
The prevalence of hypothyroidism varies from 2% to 3% following lobectomy for TA, although rates of hypothyroidism after lobectomy for nontoxic nodules have been reported to be as high as 20%, and lower after isthmusectomy when the TA is confined to the thyroid isthmus.
“The prevalence of hypothyroidism varies from 2% to 3% following lobectomy for TA, although rates of hypothyroidism after lobectomy for nontoxic nodules have been reported to be as high as 20% (254-256), and lower after isthmusectomy in the unique circumstance in which the TA is confined to the thyroid isthmus.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [254]
For patients with TA who receive RAI therapy, there is a 6%-18% risk of persistent hyperthyroidism and a 3%-5.5% risk of recurrent hyperthyroidism.
“For patients with TA who receive RAI therapy there is a 6%-18% risk of persistent hyperthyroidism and a 3%-5.5% risk of recurrent hyperthyroidism (254,257).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [254]
The literature reports a very low risk of anesthesia-related mortality associated with thyroidectomy.
“The literature reports a very low risk of anesthesiarelated mortality associated with thyroidectomy (254,283).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [254]
One large clinical series for TA demonstrated no surgical deaths and low complication rates.
“One large clinical series for TA demonstrated no surgical deaths and low complication rates (254).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [254]
Cites
Cost-Effectiveness in Health and Medicine
(1996) · doi:10.1093/oso/9780195108248.001.0001 · Cited by 7,193 · see citing works
Foundations of Cost-Effectiveness Analysis for Health and Medical Practices
Weinstein, M. C., & Stason, W. B. (1977) · New England Journal of Medicine · doi:10.1056/nejm197703312961304 · Cited by 2,133 · see citing works
Laupacis, A., Feeny, D. H., Detsky, A. S., & Tugwell, P. (1992) · Europe PMC (PubMed Central) · Cited by 1,581 · see citing works
Werner & Ingbar's the thyroid : a fundamental and clinical text
Werner, S. C., Ingbar, S. H., Braverman, L. E., & Utiger, R. D. (2012) · Lippincott-Raven eBooks · Cited by 1,016 · see citing works
Occult papillary carcinoma of the thyroid. A “normal” finding in finland. A systematic autopsy study
Harach, H. R., Franssila, K., & Wasenius, V.-M. (1985) · Cancer · doi:10.1002/1097-0142(19850801)56:3 · Cited by 939 · see citing works
Papillary thyroid microcarcinoma: A study of 900 cases observed in a 60-year period
HAY, I. D., Hutchinson, M. E., Gonzalez‐Losada, T., McIver, B., Reinalda, M. E., Grant, C. S., Thompson, G. B., Sebo, T. J., & Goellner, J. R. (2008) · Surgery · doi:10.1016/j.surg.2008.08.035 · Cited by 934 · see citing works
HAY, I. D., Grant, C. S., Taylor, W. F., et al. (1987) · PubMed · Cited by 775 · see citing works
One Thousand Health-Related Quality-of-Life Estimates
Tengs, T. O., & Wallace, A. E. (2000) · Medical Care · doi:10.1097/00005650-200006000-00004 · Cited by 658 · see citing works
Pauker, S. G., & Kassirer, J. P. (1987) · New England Journal of Medicine · doi:10.1056/nejm198701293160505 · Cited by 487 · see citing works
SINGER, P. A. (1996) · Archives of Internal Medicine · doi:10.1001/archinte.156.19.2165 · Cited by 469 · see citing works
Treatment Guidelines for Patients With Hyperthyroidism and Hypothyroidism
Singer, P. A. (1995) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1995.03520340064038 · Cited by 427 · see citing works
DOBYNS, B. M., SHELINE, G. E., WORKMAN, J. B., TOMPKINS, E. A., McCONAHEY, W. M., & BECKER, D. V. (1974) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-38-6-976 · Cited by 391 · see citing works
Cancer Mortality Following Treatment for Adult Hyperthyroidism
Ron, E. (1998) · JAMA · doi:10.1001/jama.280.4.347 · Cited by 377 · see citing works
Robinson, R. (1993) · BMJ · doi:10.1136/bmj.307.6908.859 · Cited by 366 · see citing works
Treatment Guidelines for Patients With Thyroid Nodules and Well-Differentiated Thyroid Cancer
SINGER, P. A. (1996) · Archives of Internal Medicine · doi:10.1001/archinte.1996.00440180017002 · Cited by 353 · see citing works
Levothyroxine Therapy in Patients with Thyroid Disease
Mandel, S. J., Brent, G. A., & Larsen, P. R. (1993) · Annals of Internal Medicine · doi:10.7326/0003-4819-119-6-199309150-00009 · Cited by 324 · see citing works
Cooper, D. S. (1984) · New England Journal of Medicine · doi:10.1056/nejm198411223112106 · Cited by 323 · see citing works
The Management of Hyperthyroidism
Wood, A. J. J., & Franklyn, J. A. (1994) · New England Journal of Medicine · doi:10.1056/nejm199406163302407 · Cited by 303 · see citing works
Cancer Risk After Iodine-131 Therapy for Hyperthyroidism
Holm, L., Hall, P. S., Wiklund, K., Lundell, G. E. F., Berg, G. E. B., Bjelkengren, G., Cederquist, E., Ericsson, U.-B. C., Hallquist, A., Larsson, L.-G., et al. (1991) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/83.15.1072 · Cited by 267 · see citing works
Agranulocytosis Associated with Antithyroid Drugs: Effects of Patient Age and Drug Dose
COOPER, D. S., GOLDMINZ, D., LEVIN, A. A., LADENSON, P. W., DANIELS, G. H., MOLITCH, M. E., & RIDGWAY, E. C. (1983) · Annals of Internal Medicine · doi:10.7326/0003-4819-98-1-26 · Cited by 245 · see citing works
Franklyn, J. A., Maisonneuve, P., Sheppard, M. C., Betteridge, J., & Boyle, P. (1999) · The Lancet · doi:10.1016/s0140-6736(98)12295-x · Cited by 242 · see citing works
SINGER, P. A. (1995) · JAMA · doi:10.1001/jama.273.10.808 · Cited by 235 · see citing works
Herle, A. J. V., RICH, P., LJUNG, B.-M. E., et al. (1982) · Annals of Internal Medicine · doi:10.7326/0003-4819-96-2-221 · Cited by 228 · see citing works
Controversies in the management of cold, hot, and occult thyroid nodules
Giuffrida, D., & Gharib, H. (1995) · The American Journal of Medicine · doi:10.1016/s0002-9343(99)80252-6 · Cited by 203 · see citing works
Risk group stratification and prognostic factors in papillary carcinoma of thyroid
Shaha, A. R., Shah, J. P., & Loree, T. R. (1996) · Annals of Surgical Oncology · doi:10.1007/bf02306085 · Cited by 200 · see citing works
Screening for Mild Thyroid Failure at the Periodic Health Examination
Danese, M. D. (1996) · JAMA · doi:10.1001/jama.1996.03540040029029 · Cited by 193 · see citing works
Treatment of benign nodular thyroid disease.
Hermus, A., & Huysmans, D. (1998) · New England Journal of Medicine · doi:10.1056/nejm199805143382007 · Cited by 165 · see citing works
Tajiri, J. (1990) · Archives of Internal Medicine · doi:10.1001/archinte.1990.00390150107020 · Cited by 156 · see citing works
Survival of differentiated thyroid carcinoma studied in 500 patients.
Lerch, H., Schober, O., Kuwert, T., et al. (1997) · Journal of Clinical Oncology · doi:10.1200/jco.1997.15.5.2067 · Cited by 140 · see citing works
Leese, G., Jung, R. T., Guthrie, C., Waugh, N. R., & Browning, M. C. (1992) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1992.tb01480.x · Cited by 131 · see citing works
Thyroid carcinoma in thyrotoxic patients treated by surgery
Pacini, F., Elisei, R., Coscio, G. C. D., et al. (1988) · Journal of Endocrinological Investigation · doi:10.1007/bf03350115 · Cited by 129 · see citing works
Franssila, K., & Harach, H. R. (1986) · Cancer · doi:10.1002/1097-0142(19860801)58:3 · Cited by 126 · see citing works
Optimal treatment strategy in patients with papillary thyroid cancer: A decision analysis
Esnaola, N. F., Cantor, S. B., Sherman, S. I., Lee, J. E., & Evans, D. B. (2001) · Surgery · doi:10.1067/msy.2001.118370 · Cited by 122 · see citing works
Wong, J. B., Kaplan, M. M., Meyer, K. B., et al. (1990) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(18)30319-0 · Cited by 117 · see citing works
Solitary autonomously functioning thyroid lesions
Hamburger, J. I. (1975) · The American Journal of Medicine · doi:10.1016/0002-9343(75)90630-0 · Cited by 113 · see citing works
UNUSUAL TYPES OF THYROID NEOPLASMS
Burman, K. D., Ringel, M. D., & Wartofsky, L. (1996) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(05)70312-1 · Cited by 106 · see citing works
Malignant Thyroid Tumors after Iodine-131 Therapy
Holm, L., Dahlqvist, I., Israelsson, A., & Lundell, G. E. F. (1980) · New England Journal of Medicine · doi:10.1056/nejm198007243030404 · Cited by 104 · see citing works
Follow-up of Solitary Autonomous Thyroid Nodules Treated with 131I
Goldstein, R., & Hart, I. R. (1983) · New England Journal of Medicine · doi:10.1056/nejm198312153092401 · Cited by 104 · see citing works
Incidence of hypothyroidism occurring long after iodine-131 therapy for hyperthyroidism.
Holm, L., Lundell, G. E. F., Israelsson, A., & Dahlqvist, I. (1982) · PubMed · Cited by 100 · see citing works
The Cold Thyroid Nodule: An Analysis of Diagnostic and Therapeutic Options*
Molitch, M. E., Beck, J. R., DREISMAN, M., et al. (1984) · Endocrine Reviews · doi:10.1210/edrv-5-2-185 · Cited by 97 · see citing works
Cancer Incidence Following Treatment of Hyperthyroidism
Hoffman, D. A., McConahey, W. M., Fraumeni, J. F., & Kurland, L. T. (1982) · International Journal of Epidemiology · doi:10.1093/ije/11.3.218 · Cited by 96 · see citing works
Optimized dose planning of radioiodine therapy of benign thyroidal diseases.
Bockisch, A., Jamitzky, T., Derwanz, R., & Biersack, H. J. (1993) · PubMed · Cited by 92 · see citing works
Ross, D. S., Ridgway, E. C., & DANIELS, G. H. (1984) · Annals of Internal Medicine · doi:10.7326/0003-4819-101-4-488 · Cited by 90 · see citing works
Clinical decision analysis by personal computer
Pauker, S. G. (1981) · Archives of Internal Medicine · doi:10.1001/archinte.141.13.1831 · Cited by 90 · see citing works
The American Thyroid Association
(1961) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-21-8-1021a · Cited by 85 · see citing works
Horst, W., Rösler, H., Schneider, C. G., & Labhart, A. (1967) · PubMed · Cited by 79 · see citing works
Hyperthyroidism and concurrent thyroid malignancies.
Rieger, R., Pimpl, W., Money, S., Rettenbacher, L., & Galvan, G. (1989) · PubMed · Cited by 76 · see citing works
Lau, J., Kassirer, J. P., & Pauker, S. G. (1983) · Medical Decision Making · doi:10.1177/0272989x8300300110 · Cited by 74 · see citing works
The autonomous nodule of the thyroid: correlation of patient age, nodule size and functional status
Blum, M., SHENKMAN, L., & Hollander, C. S. (1975) · The American Journal of the Medical Sciences · doi:10.1097/00000441-197501000-00006 · Cited by 69 · see citing works
Morbidity, Mortality, and Quality of Life for Patients Treated With Levothyroxine
Petersen, K. (1990) · Archives of Internal Medicine · doi:10.1001/archinte.1990.00390210063015 · Cited by 69 · see citing works
Iodine‐131 treatment of hyperthyroidism: current issues
Farrar, J., & Toft, A. D. (1991) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1991.tb03523.x · Cited by 68 · see citing works
Danese, M. D. (1996) · JAMA · doi:10.1001/jama.276.4.285 · Cited by 68 · see citing works
Agranulocytosis and antithyroid drugs.
Rosove, M. H. (1977) · PubMed · Cited by 60 · see citing works
Long-term follow-up in toxic solitary autonomous thyroid nodules treated with radioactive iodine.
Huysmans, D. A., Corstens, F. H. M., & KLOPPENBORG, P. W. C. (1991) · PubMed · Cited by 59 · see citing works
ON THE HYPERFUNCTIONING SOLITARY THYROID NODULE
Molnar, G. D., Wilber, R. D., Lee, R. E., Woolner, L. B., & KEATING, F. R. (1965) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(25)14212-2 · Cited by 58 · see citing works
Concurrent hyperthyroidism and thyroid carcinoma
Terzioğlu, T., Tezelman, S., Onaran, Y., et al. (1993) · British journal of surgery · doi:10.1002/bjs.1800801027 · Cited by 57 · see citing works
METHIMAZOLE‐INDUCED AGRANULOCYTOSIS IN JAPANESE PATIENTS WITH GRAVES’ DISEASE
Tamai, H., TAKAICHI, Y., Morita, T., Komaki, G., Matsubayashi, S., Kuma, K., Walter, R. M., Kumagai, L. F., & Nagataki, S. (1989) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1989.tb01424.x · Cited by 57 · see citing works
Hegedűs, L. D., Veiergang, D., Karstrup, S., & Hansen, J. (1986) · European Journal of Endocrinology · doi:10.1530/acta.0.1130226 · Cited by 49 · see citing works
The treatment of autonomous functioning thyroid nodules
Eyre-Brook, I. A., & Talbot, C. H. (1982) · British journal of surgery · doi:10.1002/bjs.1800691006 · Cited by 48 · see citing works
Treatment of toxic solitary thyroid nodules: surgery versus radioactive iodine.
O’Brien, T., Gharib, H., Suman, V. J., & van Heerden, J. A. (1992) · PubMed · Cited by 43 · see citing works
Current Management of the Patient with Autonomously Functioning Nodular Goiter
Thomas, C. G., & Croom, R. D. (1987) · Surgical Clinics of North America · doi:10.1016/s0039-6109(16)44186-1 · Cited by 43 · see citing works
Radioiodine treatment of solitary functioning thyroid nodules
Ratcliffe, G. E., Cooke, S. G., Fogelman, I., et al. (1986) · British Journal of Radiology · doi:10.1259/0007-1285-59-700-385 · Cited by 41 · see citing works
131I treatment of diffuse and nodular toxic goitre with or without antithyroid agents
Bliddal, H., Hansen, J., Rogowski, P., et al. (1982) · European Journal of Endocrinology · doi:10.1530/acta.0.0990517 · Cited by 34 · see citing works
The Thyroid Nodule: Diagnosis and Surgical Treatment
Lennquist, S. (1987) · Surgical Clinics of North America · doi:10.1016/s0039-6109(16)44180-0 · Cited by 34 · see citing works
Managing toxic thyroid adenoma: a cost-effectiveness analysis
Vidal-Trecan, G. M., Stahl, J., & Durand‐Zaleski, I. (2002) · European Journal of Endocrinology · doi:10.1530/eje.0.1460283 · Cited by 31 · see citing works
Self-citationThe Autonomous Functioning Thyroid Nodule
Miller, J. M. (1968) · Archives of Surgery · doi:10.1001/archsurg.1968.01330210064011 · Cited by 31 · see citing works
The dilemma of the solitary thyroid nodule: Resolution through decision analysis
Sisson, J. C., Bartol, S. P., & Bartold, S. L. (1978) · Seminars in Nuclear Medicine · doi:10.1016/s0001-2998(78)80007-5 · Cited by 30 · see citing works
Clerc, J., Dagousset, F., Izembart, M., et al. (1995) · PubMed · Cited by 29 · see citing works
Long-term studies of solitary autonomous thyroid nodules.
McCormack, K. R., & Sheline, G. E. (1967) · PubMed · Cited by 29 · see citing works
Surgical Management of the Patient with Papillary Cancer
Patwardhan, N. A., Cataldo, T. E., & Braverman, L. E. (1995) · Surgical Clinics of North America · doi:10.1016/s0039-6109(16)46633-8 · Cited by 26 · see citing works
Incidence of cancer in thyroid nodules.
Robinson, E., Horn, Y., & Hochmann, A. (1966) · PubMed · Cited by 20 · see citing works
Analyses of the Outcome of Locally Invasive Papillary Thyroid Carcinomas
Tanaka, K., Sonoo, H., Yamamoto, Y., et al. (1999) · Thyroid · doi:10.1089/thy.1999.9.1017 · Cited by 14 · see citing works
Fontana, B., Curti, G., Biggi, A., & Fresco, G. F. (1980) · PubMed · Cited by 14 · see citing works
[Complications and sequelae of thyroid surgery].
Jl, P., & Jm, Z. (1988) · PubMed · Cited by 12 · see citing works
Cost Effectiveness of Screening for Subclinical Hypothyroidism in the Elderly
Bona, M., Santini, F., Rivolta, G., Grossi, E., & Grilli, R. (1998) · PharmacoEconomics (Auckland) · doi:10.2165/00019053-199814020-00009 · Cited by 11 · see citing works
The Autonomously Functioning Thyroid Adenoma
Hamburger, J. I. (1983) · New England Journal of Medicine · doi:10.1056/nejm198312153092408 · Cited by 10 · see citing works
Cost-Effectiveness of Screening for Hypo- and Hyperthyroidism in India
Thompson, M. S., McNeil, B. J., Ganatra, R. D., et al. (1981) · Medical Decision Making · doi:10.1177/0272989x8100100107 · Cited by 6 · see citing works
Surveillance après traitement des cancers thyroïdiens différenciés
Mellière, D., Berrahal, D., Hindié, E., et al. (2000) · Annales de Chirurgie · doi:10.1016/s0003-3944(00)00008-0 · Cited by 4 · see citing works
Lenne, X., Allenet, B., Laurent, P., et al. (1999) · PubMed · Cited by 2 · see citing works
[The surgical treatment of toxic nodular goitres (author's transl)].
Garnier, H., Bacourt, F., Boucaut, P., et al. (1978) · PubMed · Cited by 2 · see citing works
Proye, C. A. G., Lagache, G., Patoir, A., et al. (1980) · PubMed · Cited by 2 · see citing works
TOURNIAIRE, J. (1971) · PubMed · Cited by 2 · see citing works
[Results of the treatment of toxique thyroid adenomas by 131-I (author's transl)].
Vallée, G., & Doumith, R. (1974) · PubMed · Cited by 2 · see citing works
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Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., et al. (2016) · Thyroid® · doi:10.1089/thy.2016.0229 · Cited by 2,938 · see citing works
“One large clinical series for TA demonstrated no surgical deaths and low complication rates (254).”
BackgroundInfluentialBahn, R. S., Burch, H. B., Cooper, D. S., Garber, J. R., Greenlee, M. C., Klein, I., Laurberg, P., McDougall, I. R., Montori, V. M., Rivkees, S. A., et al. (2011) · Endocrine Practice · doi:10.4158/ep.17.3.456 · Cited by 1,098 · see citing works
The American Thyroid Association and American Association of Clinical Endocrinologists Taskforce on Hyperthyroidism and Other Causes of Thyrotoxicosis, Bahn, R. S., Burch, H. B., Cooper, D. S., Garber, J. R., Greenlee, M. C., Klein, I., Laurberg, P., McDougall, I. R., Montori, V. M., et al. (2011) · Thyroid · doi:10.1089/thy.2010.0417 · Cited by 898 · see citing works
Comparison of four different protocols of I-131 therapy for treating single toxic thyroid nodule
Zakavi, S. R., Mousavi, Z., & Davachi, B. (2009) · Nuclear Medicine Communications · doi:10.1097/mnm.0b013e3283169148 · Cited by 36 · see citing works
- Authors
- Vidal-Trecan, G. M., Stahl, J. E., & Eckman, M. H.
- Affiliations
- Hôpital Cochin (FR)
- Massachusetts General Hospital (US)
- University of Cincinnati Medical Center (US)
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 2004-11
- Volume
- 14
- Issue
- 11
- Pages
- 933-945
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W2070700539
- Cited by
- 53
- References
- 83
- Citations by year
- 2026: 1 · 2024: 2 · 2022: 3 · 2021: 3 · 2020: 5 · 2019: 3 · 2017: 4 · 2016: 6 · 2015: 2 · 2014: 3 · 2013: 4 · 2012: 2
- FWCI
- 0.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- toxic adenoma, Graves' disease, radioiodine therapy, hemithyroidectomy, antithyroid drugs, cost-effectiveness, quality-adjusted life years, postoperative mortality, treatment decision-making, thyroid cancer
- MeSH terms
- Adenoma, Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Cost-Benefit Analysis, Dose-Response Relationship, Radiation, Female, Humans, Iodine Radioisotopes, Markov Chains, Middle Aged, Antithyroid Agents, Thyroid Neoplasms, Thyroidectomy, Thyrotoxicosis, Drug Costs, Treatment Outcome, Health Care Costs, Quality-Adjusted Life Years
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