Petros Perros
Postradioiodine Graves' management: The PRAGMA study
Perros, Petros; Basu, Ansu; Boelaert, Kristien; Dayan, Colin; Vaidya, Bijay; Williams, Graham R; Lazarus, John H; Hickey, Janis; Drake, William M; Crown, Anna; Orme, Stephen M; Johnson, Andrew; Ray, David W; Leese, Graham P; Hugh Jones, T; Abraham, Prakash; Grossman, Ashley; Rees, Aled; Razvi, Salman; Gibb, Fraser W; Moran, Carla; Madathil, Asgar; Žarković, Miloš P.; Plummer, Zoe; Jarvis, Sheba; Falinska, Agnieszka; Velusamy, Anand; Sanderson, Violet; Pariani, Nadia; Atkin, Stephen L; Syed, Akheel A; Sathyapalan, Thozhukat; Nag, Sath; Gilbert, Jackie; Gleeson, Helena; Levy, Miles J; Johnston, Colin; Sturrock, Nigel; Bennett, Stuart; Mishra, Biswa; Malik, Isha; Karavitaki, Niki
Authors
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 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
Professor Thozhukat Sathyapalan T.Sathyapalan@hull.ac.uk
Professor of Diabetes, Endocrinology and Metabolism
Sath Nag
Jackie Gilbert
Helena Gleeson
Miles J Levy
Colin Johnston
Nigel Sturrock
Stuart Bennett
Biswa Mishra
Isha Malik
Niki Karavitaki
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.
Citation
Perros, P., Basu, A., Boelaert, K., Dayan, C., Vaidya, B., Williams, G. R., …Karavitaki, N. (2022). Postradioiodine Graves' management: The PRAGMA study. Clinical Endocrinology, https://doi.org/10.1111/cen.14719
Journal Article Type | Article |
---|---|
Acceptance Date | Jan 5, 2022 |
Online Publication Date | Mar 11, 2022 |
Publication Date | 2022 |
Deposit Date | Mar 28, 2022 |
Publicly Available Date | Mar 12, 2023 |
Journal | Clinical Endocrinology |
Print ISSN | 0300-0664 |
Electronic ISSN | 1365-2265 |
Publisher | Wiley |
Peer Reviewed | Peer Reviewed |
DOI | https://doi.org/10.1111/cen.14719 |
Keywords | Graves' disease; Hyperthyroidism; Hypothyroidism; Radioiodine; Thyroid |
Public URL | https://hull-repository.worktribe.com/output/3957620 |
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©2022 The authors. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder
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