How do you choose between antithyroid drugs, RAI, and surgery for hyperthyroidism patients with existing cardiovascular disease, given their varying effects on cardiovascular outcomes?  

This recent JAMA study (Chiung-Hui Peng et al., PMID 38436957), and others like it (e.g., Okosieme et al., PMID 30827829) show higher mortality rates and CV disease in patients receiving ATDs vs RAI, or better outcomes with surgery vs both RAI and ATDs (Liu et al., PMID 35822337). The main reason ap...

There are many factors besides the presence of known CVS that may alter the decision tree. How old is the patient, does their CVD or other issue preclude surgery, the nature of the hyperthyroidism (mild autoimmune with small goiter vs a large compressive MNG), and presence of TED?

I agree with Dr. @Cooper's assessment but my rate of "failure" of RAI is 5%, not 20%.