Audit reveals lower Graves’ orbitopathy incidence after radioactive iodine treatment for Graves’ disease

A retrospective audit on patients with Graves’ disease undergoing radioactive iodine (RAI) treatment revealed a lower incidence of Graves’ orbitopathy (GO) than previously observed. The study emphasized the importance of assessing patients for GO risk factors and providing adequate counseling before initiating RAI treatment.

The cohort, including 101 patients with a median Graves’ disease duration of 36 months, saw 33.7% of patients being active or ex-smokers, 85.1% testing positive for thyroid-stimulating hormone receptor antibody (TRAb), and 10.9% having a history of GO. Overall, 31.7% presented with eye features before treatment. The median RAI dose administered was 596MBq.

Only 7.9% of patients received prophylactic corticosteroids. However, the vast majority (88.1%) achieved a hypothyroid state within a year after RAI. Despite this, GO developed in only 5% of cases, with 80% of those being de novo occurrences in high-risk individuals who did not receive steroids. One case involved GO reactivation despite steroid use. Among the affected patients, 2 required intravenous steroids with or without orbital radiotherapy, 1 completed an oral steroid taper, and the rest were managed conservatively.

Reference
Quah NQX, Sobti MM, Wren AM, et al. Radioactive iodine treatment for Graves’ hyperthyroidism: incidence of Graves orbitopathy. Nucl Med Commun. 2023;doi: 10.1097/MNM.0000000000001791. Epub ahead of print. PMID: 37982569.