**3.3 RAI therapy**

RAI treatment is a very effective therapy of GD. Accordintg to the NICE guidance, which is prepared for the National Health Service in England, it is used as first line treatment and in cases of hyperthyroidism recurrence post ATD therapy. The aim of this therapy is to radiate thyroid cells rendering the patient eu/hypothyroid. Although for many years it has been the most preferable treatment in USA, currently there is a tendency toward ATD therapy [20]. RAI treatment is performed after failure of ATD therapy to control hyperthyroidism or when the latter is contraindicated. Also RAI is preferred in patients with commodities who are at high risk of surgical complications, or in those with a history of prior surgery or irradiation of the head and neck. RAI treatment is the therapy of choice when there is no access to an experienced thyroid surgeon and in patients with periodic thyrotoxic hypokalemic paralysis, right heart failure pulmonary hypertension, or congestive heart failure [12]. RAI treatment is contraindicated when there is suspicion of thyroid cancer, in women who are pregnant or are breastfeeding and in those who cannot follow radiation safety rules. As RAI treatment has a risk of worsening Graves orbitopathy it is contraindicated in case of moderate to severe orbitopathy [12].
