Postradioiodine 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; 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

doi:10.1111/cen.14719

Postradioiodine Graves' management: The PRAGMA study

Petros Perros (Lead / Corresponding author), 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. GibbCarla 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

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

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.

Original language	English
Pages (from-to)	664-675
Number of pages	12
Journal	Clinical Endocrinology
Volume	97
Issue number	5
Early online date	11 Mar 2022
DOIs	https://doi.org/10.1111/cen.14719
Publication status	Published - Nov 2022

Keywords

Graves' disease
hyperthyroidism
hypothyroidism
radioiodine
thyroid

ASJC Scopus subject areas

Endocrinology, Diabetes and Metabolism
Endocrinology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/cen.14719

Cite this

Perros, P., Basu, A., Boelaert, K., Dayan, C., Vaidya, B., Williams, G. R., Lazarus, J. H., Hickey, J., Drake, W. M., Crown, A., Orme, S. M., Johnson, A., Ray, D. W., Leese, G. P., Jones, T. H., Abraham, P., Grossman, A., Rees, A., Razvi, S., ... Karavitaki, N. (2022). Postradioiodine Graves' management: The PRAGMA study. Clinical Endocrinology, 97(5), 664-675. https://doi.org/10.1111/cen.14719

@article{c11c0c5fd4d641c0a61f0bf54f337064,

title = "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.",

keywords = "Graves' disease, hyperthyroidism, hypothyroidism, radioiodine, thyroid",

author = "Petros Perros and Ansu Basu and Kristien Boelaert and Colin Dayan and Bijay Vaidya and Williams, {Graham R.} and Lazarus, {John H.} and Janis Hickey and Drake, {William M.} and Anna Crown and Orme, {Stephen M.} and Andrew Johnson and Ray, {David W.} and Leese, {Graham P.} and Jones, {Thomas Hugh} and Prakash Abraham and Ashley Grossman and Aled Rees and Salman Razvi and Gibb, {Fraser W.} and Carla Moran and Asgar Madathil and {\v Z}arkovi{\'c}, {Milo{\v s} P.} and Zoe Plummer and Sheba Jarvis and Agnieszka Falinska and Anand Velusamy and Violet Sanderson and Nadia Pariani and Atkin, {Stephen L.} and Syed, {Akheel A.} and Thozhukat Sathyapalan and Sath Nag and Jackie Gilbert and Helena Gleeson and Levy, {Miles J.} and Colin Johnston and Nigel Sturrock and Stuart Bennett and Biswa Mishra and Isha Malik and Niki Karavitaki",

note = "Publisher Copyright: {\textcopyright} 2022 John Wiley & Sons Ltd.",

year = "2022",

month = nov,

doi = "10.1111/cen.14719",

language = "English",

volume = "97",

pages = "664--675",

journal = "Clinical Endocrinology",

issn = "0300-0664",

publisher = "Wiley-Blackwell",

number = "5",

}

Perros, P, Basu, A, Boelaert, K, Dayan, C, Vaidya, B, Williams, GR, Lazarus, JH, Hickey, J, Drake, WM, Crown, A, Orme, SM, Johnson, A, Ray, DW, Leese, GP, Jones, TH, Abraham, P, Grossman, A, Rees, A, Razvi, S, Gibb, FW, Moran, C, Madathil, A, Žarković, MP, Plummer, Z, Jarvis, S, Falinska, A, Velusamy, A, Sanderson, V, Pariani, N, Atkin, SL, Syed, AA, Sathyapalan, T, Nag, S, Gilbert, J, Gleeson, H, Levy, MJ, Johnston, C, Sturrock, N, Bennett, S, Mishra, B, Malik, I & Karavitaki, N 2022, 'Postradioiodine Graves' management: The PRAGMA study', Clinical Endocrinology, vol. 97, no. 5, pp. 664-675. https://doi.org/10.1111/cen.14719

TY - JOUR

T1 - Postradioiodine Graves' management

T2 - The PRAGMA study

AU - Perros, Petros

AU - Basu, Ansu

AU - Boelaert, Kristien

AU - Dayan, Colin

AU - Vaidya, Bijay

AU - Williams, Graham R.

AU - Lazarus, John H.

AU - Hickey, Janis

AU - Drake, William M.

AU - Crown, Anna

AU - Orme, Stephen M.

AU - Johnson, Andrew

AU - Ray, David W.

AU - Leese, Graham P.

AU - Jones, Thomas Hugh

AU - Abraham, Prakash

AU - Grossman, Ashley

AU - Rees, Aled

AU - Razvi, Salman

AU - Gibb, Fraser W.

AU - Moran, Carla

AU - Madathil, Asgar

AU - Žarković, Miloš P.

AU - Plummer, Zoe

AU - Jarvis, Sheba

AU - Falinska, Agnieszka

AU - Velusamy, Anand

AU - Sanderson, Violet

AU - Pariani, Nadia

AU - Atkin, Stephen L.

AU - Syed, Akheel A.

AU - Sathyapalan, Thozhukat

AU - Nag, Sath

AU - Gilbert, Jackie

AU - Gleeson, Helena

AU - Levy, Miles J.

AU - Johnston, Colin

AU - Sturrock, Nigel

AU - Bennett, Stuart

AU - Mishra, Biswa

AU - Malik, Isha

AU - Karavitaki, Niki

PY - 2022/11

Y1 - 2022/11

N2 - 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.

AB - 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.

KW - Graves' disease

KW - hyperthyroidism

KW - hypothyroidism

KW - radioiodine

KW - thyroid

U2 - 10.1111/cen.14719

DO - 10.1111/cen.14719

M3 - Article

C2 - 35274331

AN - SCOPUS:85126783449

SN - 0300-0664

VL - 97

SP - 664

EP - 675

JO - Clinical Endocrinology

JF - Clinical Endocrinology

IS - 5

ER -

Postradioiodine Graves' management: The PRAGMA study

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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