Post-radioiodine Graves’ management: the PRAGMA study

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, T Hugh Jones, Prakash Abraham, Ashley Grossman, Aled Rees, Salman Razvi, Fraser W GibbCarla Moran, Asgar Madathil, Miloš P. Žarković, Zoe Plummer, Sheba Jarvis, Agnieszka Falinska, Anand Velusamy, Violet Sanderson, Nadia Parian, 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

Research output: Contribution to journalArticlepeer-review

Abstract

Design
Retrospective, multi-centre, observational study.

Patients
Adult patients with Graves’ disease treated with radioiodine with 12 months’ follow-up.

Measurements
Euthyroidism was defined as both serum thyrotropin (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; subclinical hyperthyroidism as low TSH and normal FT4

Results
Of 812 patients studied post-radioiodine, hypothyroidism occurred in 80.7% and hyperthyroidism in 48.6% of patients. Three principal post-radioiodine management strategies were employed: (a) anti-thyroid 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, cardiovascular events), were associated with dysthyroidism. There were significant differences in demographics, clinical practice, and thyroid status post-radioiodine between centres.

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

CLINICAL TRIAL REGISTRATION
Clinical.trials.gov (identifier No. NCT01885533).
Original languageEnglish
JournalClinical Endocrinology
Early online date11 Mar 2022
DOIs
Publication statusE-pub ahead of print - 11 Mar 2022

Keywords

  • Graves' disease
  • hyperthyroidism
  • hypothyroidism
  • radioiodine
  • thyroid

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