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Post-radioiodine Graves' management: the PRAGMA study

Perros, Petros, Basu, Ansu, Boelaert, Kristien, Dayan, Colin, Vaidya, Bijay, Williams, Graham, Lazarus, John and Rees, D. Aled 2022. Post-radioiodine Graves' management: the PRAGMA study. Clinical Endocrinology 10.1111/cen.14719
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Abstract

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

Item Type: Article
Date Type: Published Online
Status: In Press
Schools: Medicine
Neuroscience and Mental Health Research Institute (NMHRI)
MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Publisher: Society for Endocrinology
ISSN: 0300-0664
Date of First Compliant Deposit: 11 January 2022
Date of Acceptance: 5 January 2022
Last Modified: 19 May 2022 17:43
URI: https://orca.cardiff.ac.uk/id/eprint/146461

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