Postradioiodine Graves' management: The PRAGMA study.

Abstract

OBJECTIVE:

Thyroid status in the months following radioiodine (RI) treatment for Graves' disease can be unstable. Our objective was to quantify frequency of abnormal thyroid function post-RI and compare effectiveness of common management strategies.

DESIGN:

Retrospective, multicentre and observational study.

PATIENTS:

Adult patients with Graves' disease treated with RI with 12 months' follow-up.

MEASUREMENTS:

Euthyroidism was defined as both serum thyrotropin (thyroid-stimulating hormone [TSH]) and free thyroxine (FT4) within their reference ranges or, when only one was available, it was within its reference range; hypothyroidism as TSH ≥ 10 mU/L, or subnormal FT4 regardless of TSH; hyperthyroidism as TSH below and FT4 above their reference ranges; dysthyroidism as the sum of hypo- and hyperthyroidism; subclinical hypothyroidism as normal FT4 and TSH between the upper limit of normal and <10 mU/L; and subclinical hyperthyroidism as low TSH and normal FT4.

RESULTS:

Of 812 patients studied post-RI, hypothyroidism occurred in 80.7% and hyperthyroidism in 48.6% of patients. Three principal post-RI management strategies were employed: (a) antithyroid drugs alone, (b) levothyroxine alone, and (c) combination of the two. Differences among these were small. Adherence to national guidelines regarding monitoring thyroid function in the first 6 months was low (21.4%-28.7%). No negative outcomes (new-onset/exacerbation of Graves' orbitopathy, weight gain, and cardiovascular events) were associated with dysthyroidism. There were significant differences in demographics, clinical practice, and thyroid status postradioiodine between centres.

CONCLUSIONS:

Dysthyroidism in the 12 months post-RI was common. Differences between post-RI strategies were small, suggesting these interventions alone are unlikely to address the high frequency of dysthyroidism.

• Authors: Petros Perros, Ansu Basu, Kristien Boelaert, Colin Dayan, Bijay Vaidya, Graham R Williams, John H Lazarus, Janis Hickey, William M Drake, Anna Crown, Stephen M Orme, Andrew Johnson, David W Ray, Graham P Leese, Thomas Hugh Jones, Prakash Abraham, Ashley Grossman, Aled Rees, Salman Razvi, Fraser W Gibb, Carla Moran, Asgar Madathil, Miloš P Žarković, Zoe Plummer, Sheba Jarvis, Agnieszka Falinska, Anand Velusamy, Violet Sanderson, Nadia Pariani, Stephen L Atkin, Akheel A Syed, Thozhukat Sathyapalan, Sath Nag, Jackie Gilbert, Helena Gleeson, Miles J Levy, Colin Johnston, Nigel Sturrock, Stuart Bennett, Biswa Mishra, Isha Malik, Niki Karavitaki
• Journal: Clinical endocrinology (Clin Endocrinol (Oxf)) Vol. 97 Issue 5 Pg. 664-675 (11 2022) ISSN: 1365-2265 [Electronic] England
• PMID: 35274331 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2022 John Wiley & Sons Ltd.

Chemical References

• Antithyroid Agents
• Iodine Radioisotopes
• Thyrotropin
• Thyroxine

Topics

• Adult
• Antithyroid Agents (therapeutic use)
• Graves Disease (radiotherapy)
• Graves Ophthalmopathy
• Humans
• Hyperthyroidism (radiotherapy)
• Hypothyroidism (drug therapy)
• Iodine Radioisotopes (therapeutic use)
• Retrospective Studies
• Thyrotropin
• Thyroxine (therapeutic use)