Key result
Whole-gland RFA linked to a ~88% lower rate of permanent hypothyroidism versus radioiodine while achieving remission.
Why the study?
Graves' disease commonly relapses after antithyroid drug therapy, whereas radioiodine and surgery usually lead to permanent hypothyroidism.
Does single-session whole-gland radiofrequency ablation improve remission and reduce permanent hypothyroidism compared to I-131 radioiodine in adults with persistent or relapsed Graves' disease?
Observational (n=29)
No
Does single-session whole-gland radiofrequency ablation improve remission and reduce permanent hypothyroidism compared to I-131 radioiodine in adults with persistent or relapsed Graves' disease?
Single-session whole-gland RFA offers a promising alternative to radioiodine for relapsed Graves' disease, achieving high remission rates with a substantially lower risk of permanent hypothyroidism.
RFA may support remission with lower hypothyroidism risk than RAI; randomized trials needed before practice change.
Objective Graves' disease (GD) commonly relapses after antithyroid drug (ATD) therapy, whereas radioiodine (RAI) and surgery usually culminate in permanent hypothyroidism. We evaluated the efficacy and safety of single-session whole-gland radiofrequency ablation (RFA) as a second-line treatment for persistent or relapsed GD in an Indian cohort, with a contemporaneous observational I-131 RAI comparator. Methods In this prospective single-center observational study reported in accordance with STROBE, 18 adults with biochemically confirmed persistent or relapsed GD underwent ultrasound-guided whole-gland RFA after achieving euthyroidism on ATDs. A contemporaneous comparator cohort of 11 patients with persistent or relapsed GD received I-131 RAI after shared decision-making. The primary outcome was remission, defined as sustained euthyroidism or hypothyroidism off ATDs. Secondary outcomes included thyroid volume reduction ratio (VRR), reduction in ATD requirement, and safety. Results After RFA, remission was observed in 44.4% at 1 month, 55.6% at 3 months, 66.7% at 6 months, and 72.2% at 12 months. Mean VRR increased progressively to 61.3% at 12 months and correlated with biochemical improvement. Permanent hypothyroidism occurred in 2 of 18 patients (11.1%) after RFA versus 10 of 11 (90.9%) after RAI. No major RFA-related complications, thyroid storm, or worsening of ophthalmopathy were observed. Among the 5 RFA non-remitters, ATD dose requirements fell by 62.8% by 12 months; no repeat RFA was performed during protocol follow-up. Conclusion Single-session whole-gland RFA showed promising short-term efficacy and a substantially lower rate of hypothyroidism than RAI in carefully selected patients with persistent or relapsed GD. Given the nonrandomized design, small sample, and limited long-term follow-up for late relapse, these findings should be interpreted as hypothesis-generating.
No takes yet. Share an insight, caveat, or question.
Ahmed et al. (2026) conducted an observational in Persistent or relapsed Graves' disease (n=29). Single-session whole-gland radiofrequency ablation (RFA) vs. I-131 Radioiodine (RAI) was evaluated on Remission, defined as sustained euthyroidism or hypothyroidism off antithyroid drugs. Single-session whole-gland RFA achieved a 72.2% remission rate at 12 months and resulted in a lower rate of permanent hypothyroidism compared to radioiodine (11.1% vs 90.9%).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: