Cardiff University | Prifysgol Caerdydd ORCA
Online Research @ Cardiff 
WelshClear Cookie - decide language by browser settings

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
Item availability restricted.

[thumbnail of PRAGMA_Perros_etal_ClinEndo_4.1.22_FINAL (1).pdf] PDF - Accepted Post-Print Version
Restricted to Repository staff only until 11 March 2023 due to copyright restrictions.

Download (852kB)


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

Actions (repository staff only)

Edit Item Edit Item


Downloads per month over past year

View more statistics