Postradioiodine Graves' management: The PRAGMA study
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 observat...
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| Veröffentlicht in: | Clinical endocrinology (Oxford) 2022-11, Vol.97 (5), p.664-675 |
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| creator | 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. Jones, Thomas Hugh 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 |
| description | 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 |
| doi_str_mv | 10.1111/cen.14719 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2638715145</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2638715145</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3889-ed2b6bd084d0c76da0ec2ba313169c6b12e3ae5c102c93a64841b4c0b464d72c3</originalsourceid><addsrcrecordid>eNp1kMtKw0AUQAdRbK0u_AEJuFAXaeeVSeKulFoFH0XqepjM3GpKHnUmUfr3Tk11IXg3d3M43HsQOiV4SPyMNFRDwmOS7qE-YSIKKRXRPupjhnGIheA9dOTcCmMcJTg-RD0W0ZgzRvqIz2vXWGXyOq9NXkEws-oD3EVQqkq9QglVcx0s3iCYP49nD-PANa3ZHKODpSocnOz2AL3cTBeT2_D-aXY3Gd-HmiVJGoKhmcgMTrjBOhZGYdA0U4wwIlItMkKBKYg0wVSnTAmecJJxjTMuuImpZgN02XnXtn5vwTWyzJ2GolAV1K2TVLAkJhHhkUfP_6CrurWVv07SmPoTtq976qqjtK2ds7CUa5uXym4kwXKbUvqU8julZ892xjYrwfySP-08MOqAz7yAzf8mOZk-dsovs716Rw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2720840580</pqid></control><display><type>article</type><title>Postradioiodine Graves' management: The PRAGMA study</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>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. ; Jones, Thomas Hugh ; 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</creator><creatorcontrib>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. ; Jones, Thomas Hugh ; 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</creatorcontrib><description>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.</description><identifier>ISSN: 0300-0664</identifier><identifier>EISSN: 1365-2265</identifier><identifier>DOI: 10.1111/cen.14719</identifier><identifier>PMID: 35274331</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Antithyroid Agents - therapeutic use ; Graves disease ; Graves Disease - radiotherapy ; Graves Ophthalmopathy ; Humans ; Hyperthyroidism ; Hyperthyroidism - radiotherapy ; Hypothyroidism ; Hypothyroidism - drug therapy ; Iodine Radioisotopes - therapeutic use ; Patients ; radioiodine ; Retrospective Studies ; Thyroid ; Thyroid gland ; Thyroid-stimulating hormone ; Thyrotropin ; Thyroxine ; Thyroxine - therapeutic use</subject><ispartof>Clinical endocrinology (Oxford), 2022-11, Vol.97 (5), p.664-675</ispartof><rights>2022 John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3889-ed2b6bd084d0c76da0ec2ba313169c6b12e3ae5c102c93a64841b4c0b464d72c3</citedby><cites>FETCH-LOGICAL-c3889-ed2b6bd084d0c76da0ec2ba313169c6b12e3ae5c102c93a64841b4c0b464d72c3</cites><orcidid>0000-0003-0570-5678 ; 0000-0003-3544-2231 ; 0000-0002-1165-9092 ; 0000-0001-7320-5574 ; 0000-0002-2223-0494 ; 0000-0002-4739-6773</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fcen.14719$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fcen.14719$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35274331$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Perros, Petros</creatorcontrib><creatorcontrib>Basu, Ansu</creatorcontrib><creatorcontrib>Boelaert, Kristien</creatorcontrib><creatorcontrib>Dayan, Colin</creatorcontrib><creatorcontrib>Vaidya, Bijay</creatorcontrib><creatorcontrib>Williams, Graham R.</creatorcontrib><creatorcontrib>Lazarus, John H.</creatorcontrib><creatorcontrib>Hickey, Janis</creatorcontrib><creatorcontrib>Drake, William M.</creatorcontrib><creatorcontrib>Crown, Anna</creatorcontrib><creatorcontrib>Orme, Stephen M.</creatorcontrib><creatorcontrib>Johnson, Andrew</creatorcontrib><creatorcontrib>Ray, David W.</creatorcontrib><creatorcontrib>Leese, Graham P.</creatorcontrib><creatorcontrib>Jones, Thomas Hugh</creatorcontrib><creatorcontrib>Abraham, Prakash</creatorcontrib><creatorcontrib>Grossman, Ashley</creatorcontrib><creatorcontrib>Rees, Aled</creatorcontrib><creatorcontrib>Razvi, Salman</creatorcontrib><creatorcontrib>Gibb, Fraser W.</creatorcontrib><creatorcontrib>Moran, Carla</creatorcontrib><creatorcontrib>Madathil, Asgar</creatorcontrib><creatorcontrib>Žarković, Miloš P.</creatorcontrib><creatorcontrib>Plummer, Zoe</creatorcontrib><creatorcontrib>Jarvis, Sheba</creatorcontrib><creatorcontrib>Falinska, Agnieszka</creatorcontrib><creatorcontrib>Velusamy, Anand</creatorcontrib><creatorcontrib>Sanderson, Violet</creatorcontrib><creatorcontrib>Pariani, Nadia</creatorcontrib><creatorcontrib>Atkin, Stephen L.</creatorcontrib><creatorcontrib>Syed, Akheel A.</creatorcontrib><creatorcontrib>Sathyapalan, Thozhukat</creatorcontrib><creatorcontrib>Nag, Sath</creatorcontrib><creatorcontrib>Gilbert, Jackie</creatorcontrib><creatorcontrib>Gleeson, Helena</creatorcontrib><creatorcontrib>Levy, Miles J.</creatorcontrib><creatorcontrib>Johnston, Colin</creatorcontrib><creatorcontrib>Sturrock, Nigel</creatorcontrib><creatorcontrib>Bennett, Stuart</creatorcontrib><creatorcontrib>Mishra, Biswa</creatorcontrib><creatorcontrib>Malik, Isha</creatorcontrib><creatorcontrib>Karavitaki, Niki</creatorcontrib><title>Postradioiodine Graves' management: The PRAGMA study</title><title>Clinical endocrinology (Oxford)</title><addtitle>Clin Endocrinol (Oxf)</addtitle><description>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.</description><subject>Adult</subject><subject>Antithyroid Agents - therapeutic use</subject><subject>Graves disease</subject><subject>Graves Disease - radiotherapy</subject><subject>Graves Ophthalmopathy</subject><subject>Humans</subject><subject>Hyperthyroidism</subject><subject>Hyperthyroidism - radiotherapy</subject><subject>Hypothyroidism</subject><subject>Hypothyroidism - drug therapy</subject><subject>Iodine Radioisotopes - therapeutic use</subject><subject>Patients</subject><subject>radioiodine</subject><subject>Retrospective Studies</subject><subject>Thyroid</subject><subject>Thyroid gland</subject><subject>Thyroid-stimulating hormone</subject><subject>Thyrotropin</subject><subject>Thyroxine</subject><subject>Thyroxine - therapeutic use</subject><issn>0300-0664</issn><issn>1365-2265</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kMtKw0AUQAdRbK0u_AEJuFAXaeeVSeKulFoFH0XqepjM3GpKHnUmUfr3Tk11IXg3d3M43HsQOiV4SPyMNFRDwmOS7qE-YSIKKRXRPupjhnGIheA9dOTcCmMcJTg-RD0W0ZgzRvqIz2vXWGXyOq9NXkEws-oD3EVQqkq9QglVcx0s3iCYP49nD-PANa3ZHKODpSocnOz2AL3cTBeT2_D-aXY3Gd-HmiVJGoKhmcgMTrjBOhZGYdA0U4wwIlItMkKBKYg0wVSnTAmecJJxjTMuuImpZgN02XnXtn5vwTWyzJ2GolAV1K2TVLAkJhHhkUfP_6CrurWVv07SmPoTtq976qqjtK2ds7CUa5uXym4kwXKbUvqU8julZ892xjYrwfySP-08MOqAz7yAzf8mOZk-dsovs716Rw</recordid><startdate>202211</startdate><enddate>202211</enddate><creator>Perros, Petros</creator><creator>Basu, Ansu</creator><creator>Boelaert, Kristien</creator><creator>Dayan, Colin</creator><creator>Vaidya, Bijay</creator><creator>Williams, Graham R.</creator><creator>Lazarus, John H.</creator><creator>Hickey, Janis</creator><creator>Drake, William M.</creator><creator>Crown, Anna</creator><creator>Orme, Stephen M.</creator><creator>Johnson, Andrew</creator><creator>Ray, David W.</creator><creator>Leese, Graham P.</creator><creator>Jones, Thomas Hugh</creator><creator>Abraham, Prakash</creator><creator>Grossman, Ashley</creator><creator>Rees, Aled</creator><creator>Razvi, Salman</creator><creator>Gibb, Fraser W.</creator><creator>Moran, Carla</creator><creator>Madathil, Asgar</creator><creator>Žarković, Miloš P.</creator><creator>Plummer, Zoe</creator><creator>Jarvis, Sheba</creator><creator>Falinska, Agnieszka</creator><creator>Velusamy, Anand</creator><creator>Sanderson, Violet</creator><creator>Pariani, Nadia</creator><creator>Atkin, Stephen L.</creator><creator>Syed, Akheel A.</creator><creator>Sathyapalan, Thozhukat</creator><creator>Nag, Sath</creator><creator>Gilbert, Jackie</creator><creator>Gleeson, Helena</creator><creator>Levy, Miles J.</creator><creator>Johnston, Colin</creator><creator>Sturrock, Nigel</creator><creator>Bennett, Stuart</creator><creator>Mishra, Biswa</creator><creator>Malik, Isha</creator><creator>Karavitaki, Niki</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0570-5678</orcidid><orcidid>https://orcid.org/0000-0003-3544-2231</orcidid><orcidid>https://orcid.org/0000-0002-1165-9092</orcidid><orcidid>https://orcid.org/0000-0001-7320-5574</orcidid><orcidid>https://orcid.org/0000-0002-2223-0494</orcidid><orcidid>https://orcid.org/0000-0002-4739-6773</orcidid></search><sort><creationdate>202211</creationdate><title>Postradioiodine Graves' management: The PRAGMA study</title><author>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. ; Jones, Thomas Hugh ; 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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3889-ed2b6bd084d0c76da0ec2ba313169c6b12e3ae5c102c93a64841b4c0b464d72c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Antithyroid Agents - therapeutic use</topic><topic>Graves disease</topic><topic>Graves Disease - radiotherapy</topic><topic>Graves Ophthalmopathy</topic><topic>Humans</topic><topic>Hyperthyroidism</topic><topic>Hyperthyroidism - radiotherapy</topic><topic>Hypothyroidism</topic><topic>Hypothyroidism - drug therapy</topic><topic>Iodine Radioisotopes - therapeutic use</topic><topic>Patients</topic><topic>radioiodine</topic><topic>Retrospective Studies</topic><topic>Thyroid</topic><topic>Thyroid gland</topic><topic>Thyroid-stimulating hormone</topic><topic>Thyrotropin</topic><topic>Thyroxine</topic><topic>Thyroxine - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Perros, Petros</creatorcontrib><creatorcontrib>Basu, Ansu</creatorcontrib><creatorcontrib>Boelaert, Kristien</creatorcontrib><creatorcontrib>Dayan, Colin</creatorcontrib><creatorcontrib>Vaidya, Bijay</creatorcontrib><creatorcontrib>Williams, Graham R.</creatorcontrib><creatorcontrib>Lazarus, John H.</creatorcontrib><creatorcontrib>Hickey, Janis</creatorcontrib><creatorcontrib>Drake, William M.</creatorcontrib><creatorcontrib>Crown, Anna</creatorcontrib><creatorcontrib>Orme, Stephen M.</creatorcontrib><creatorcontrib>Johnson, Andrew</creatorcontrib><creatorcontrib>Ray, David W.</creatorcontrib><creatorcontrib>Leese, Graham P.</creatorcontrib><creatorcontrib>Jones, Thomas Hugh</creatorcontrib><creatorcontrib>Abraham, Prakash</creatorcontrib><creatorcontrib>Grossman, Ashley</creatorcontrib><creatorcontrib>Rees, Aled</creatorcontrib><creatorcontrib>Razvi, Salman</creatorcontrib><creatorcontrib>Gibb, Fraser W.</creatorcontrib><creatorcontrib>Moran, Carla</creatorcontrib><creatorcontrib>Madathil, Asgar</creatorcontrib><creatorcontrib>Žarković, Miloš P.</creatorcontrib><creatorcontrib>Plummer, Zoe</creatorcontrib><creatorcontrib>Jarvis, Sheba</creatorcontrib><creatorcontrib>Falinska, Agnieszka</creatorcontrib><creatorcontrib>Velusamy, Anand</creatorcontrib><creatorcontrib>Sanderson, Violet</creatorcontrib><creatorcontrib>Pariani, Nadia</creatorcontrib><creatorcontrib>Atkin, Stephen L.</creatorcontrib><creatorcontrib>Syed, Akheel A.</creatorcontrib><creatorcontrib>Sathyapalan, Thozhukat</creatorcontrib><creatorcontrib>Nag, Sath</creatorcontrib><creatorcontrib>Gilbert, Jackie</creatorcontrib><creatorcontrib>Gleeson, Helena</creatorcontrib><creatorcontrib>Levy, Miles J.</creatorcontrib><creatorcontrib>Johnston, Colin</creatorcontrib><creatorcontrib>Sturrock, Nigel</creatorcontrib><creatorcontrib>Bennett, Stuart</creatorcontrib><creatorcontrib>Mishra, Biswa</creatorcontrib><creatorcontrib>Malik, Isha</creatorcontrib><creatorcontrib>Karavitaki, Niki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical endocrinology (Oxford)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Perros, Petros</au><au>Basu, Ansu</au><au>Boelaert, Kristien</au><au>Dayan, Colin</au><au>Vaidya, Bijay</au><au>Williams, Graham R.</au><au>Lazarus, John H.</au><au>Hickey, Janis</au><au>Drake, William M.</au><au>Crown, Anna</au><au>Orme, Stephen M.</au><au>Johnson, Andrew</au><au>Ray, David W.</au><au>Leese, Graham P.</au><au>Jones, Thomas Hugh</au><au>Abraham, Prakash</au><au>Grossman, Ashley</au><au>Rees, Aled</au><au>Razvi, Salman</au><au>Gibb, Fraser W.</au><au>Moran, Carla</au><au>Madathil, Asgar</au><au>Žarković, Miloš P.</au><au>Plummer, Zoe</au><au>Jarvis, Sheba</au><au>Falinska, Agnieszka</au><au>Velusamy, Anand</au><au>Sanderson, Violet</au><au>Pariani, Nadia</au><au>Atkin, Stephen L.</au><au>Syed, Akheel A.</au><au>Sathyapalan, Thozhukat</au><au>Nag, Sath</au><au>Gilbert, Jackie</au><au>Gleeson, Helena</au><au>Levy, Miles J.</au><au>Johnston, Colin</au><au>Sturrock, Nigel</au><au>Bennett, Stuart</au><au>Mishra, Biswa</au><au>Malik, Isha</au><au>Karavitaki, Niki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Postradioiodine Graves' management: The PRAGMA study</atitle><jtitle>Clinical endocrinology (Oxford)</jtitle><addtitle>Clin Endocrinol (Oxf)</addtitle><date>2022-11</date><risdate>2022</risdate><volume>97</volume><issue>5</issue><spage>664</spage><epage>675</epage><pages>664-675</pages><issn>0300-0664</issn><eissn>1365-2265</eissn><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.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>35274331</pmid><doi>10.1111/cen.14719</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-0570-5678</orcidid><orcidid>https://orcid.org/0000-0003-3544-2231</orcidid><orcidid>https://orcid.org/0000-0002-1165-9092</orcidid><orcidid>https://orcid.org/0000-0001-7320-5574</orcidid><orcidid>https://orcid.org/0000-0002-2223-0494</orcidid><orcidid>https://orcid.org/0000-0002-4739-6773</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0300-0664 |
| ispartof | Clinical endocrinology (Oxford), 2022-11, Vol.97 (5), p.664-675 |
| issn | 0300-0664 1365-2265 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2638715145 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Antithyroid Agents - therapeutic use Graves disease Graves Disease - radiotherapy Graves Ophthalmopathy Humans Hyperthyroidism Hyperthyroidism - radiotherapy Hypothyroidism Hypothyroidism - drug therapy Iodine Radioisotopes - therapeutic use Patients radioiodine Retrospective Studies Thyroid Thyroid gland Thyroid-stimulating hormone Thyrotropin Thyroxine Thyroxine - therapeutic use |
| title | Postradioiodine Graves' management: The PRAGMA study |
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