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There is continuing debate on the optimal treatment for Grave's thyrotoxicosis with a resultant variation in clinical practice. The present study aimed to ascertain changes in practice in the treatment of Grave's thyrotoxicosis in Tayside, Scotland, over the past four decades.  Methods . The “Scottish automated follow-up register” (SAFUR) was queried to identify all patients treated for Grave's thyrotoxicosis from 1968 to 2007 inclusive. Patients were divided into 4 groups (Groups A to D) according to the decades. Demographic profile, treatment modalities, radioactive iodine (RAI) dose, and recurrence rates were studied and outcomes were compared by  χ   2  test and ANOVA using SPSS v15.0. A  p  value of < 0.05 was considered significant.  Results . Altogether, 3737 patients were diagnosed with Grave's thyrotoxicosis over the 4 decades. Use of RAI has increased from 43.1% in Group A to 68% in Group D ( p  < 0.001). The dose of RAI has increased ( p  < 0.001) and there has been a reduction in recurrence rate with higher dose of RAI. Surgical intervention rates decreased from 55.3% to 12.3% ( p  < 0.001) over time.  Conclusions . Analysis of a large dataset of patients with Grave's thyrotoxicosis suggests increasing use of RAI as the preferred first line of treatment. Furthermore, using a single higher dose of RAI and adoption of total thyroidectomy have decreased recurrence rates.

Change in Practice over Four Decades in the Management of Graves’ Disease in Scotland