Radioactive Iodine Treatment for Graves’ Hyperthyroidism: Incidence of Graves Orbitopathy

Abstract

Abstract Purpose: There is limited recent data on the effect of radioactive iodine (RAI) for Graves’ disease on Graves’ orbitopathy (GO) development or reactivation. This audit investigates the GO incidence in patients with Graves’ disease after RAI treatment, explores risk factors present, and steroid prophylaxis use. Methods: A retrospective audit of Graves’ disease patients treated with RAI over a 5-year period. Data collected: smoking status, thyroid-stimulating hormone receptor antibody (TRAb) status, GO history, Graves’ disease duration, eye features pre- and post-treatment, prophylactic corticosteroids, RAI dose given, post-RAI thyroid status, duration until hypothyroid. Results: 101 patients were included, with median Graves’ disease duration 36 months. 34/101 (33.7%) were active/ex-smokers, 86/101 (85.1%) were TRAb-positive, 11/101 (10.9%) had a GO history; 32 (31.7%) had eye features present. Median RAI dose given was 596MBq. 8/101 (7.9%) patients received prophylactic corticosteroid; 1 experienced a wrist fracture. 89/101 (88.1%) achieved hypothyroid state in the year after RAI. GO developed in 5/101 (5.0%), of which 4/5 (80%) were de novo in high-risk individuals who did not receive steroids. One was a GO reactivation despite steroids. Two required intravenous steroids with/without orbital radiotherapy, one completed oral steroid taper; the remainder were treated conservatively. Conclusion: Our cohort had a lower GO incidence in patients with Graves’ disease receiving RAI, with majority arising de novo. It is essential that all patients are assessed for eye disease or risk factors and counselled adequately prior to RAI. The decision to initiate steroids should be undertaken in a multi-disciplinary setting involving endocrinologists and ophthalmologists.