Predicting outcomes and complications following radioiodine therapy in Graves' thyrotoxicosis

Ei Thuzar Aung, Nicola N Zammitt, Anna R Dover, Mark Wj Strachan, Jonathan R Seckl, Fraser W Gibb

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: Radioiodine (RAI) is an effective treatment for Graves' thyrotoxicosis but is associated with a failure rate of 15% and may be a risk factor for thyroid eye disease (TED) and weight gain. We sought to examine predictors of RAI failure, weight gain, TED and patient satisfaction.

DESIGN: Retrospective cohort study.

PATIENTS: 655 episodes of RAI in Graves' thyrotoxicosis patients (2006 - 2015).

MEASUREMENTS: Biochemical assessment, including TFTs and thyrotropin receptor antibodies (TRAb), clinical features (e.g. TED, weight, thionamide use) and patient questionnaire.

RESULTS: The treatment failure rate was 17%. Failure was greater with higher fT4 (P = 0.002) and higher TRAb (P = 0.004). Failure rate was 42.2% when TRAb > 40U/L. Median weight gain was 3.2kg in those with normal fT4 prior to RAI and 5.8kg when fT4 was elevated (P < 0.001). New TED developed in 7.6% but was not associated with post-RAI dysthyroidism. Treatment satisfaction was generally high (median response 8/10).

CONCLUSIONS: Treatment failure after RAI occurs in predictable groups and this should be reflected in the information provided to patients. Weight gain is common and may not entirely be explained by a return to pre-thyrotoxic baseline. We were unable to detect any significant impact of post-RAI dysthryoidism on weight gain, TED or thyroid symptoms in this large cohort. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalClinical Endocrinology
Early online date6 Oct 2018
DOIs
Publication statusE-pub ahead of print - 6 Oct 2018

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