Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2022 Nov;97(5):664-675.
doi: 10.1111/cen.14719. Epub 2022 Mar 21.

Postradioiodine Graves' management: The PRAGMA study

Petros Perros  1 , Ansu Basu  2 , Kristien Boelaert  3 , Colin Dayan  4 , Bijay Vaidya  5 , Graham R Williams  6 , John H Lazarus  4 , Janis Hickey  7 , William M Drake  8 , Anna Crown  9 , Stephen M Orme  10 , Andrew Johnson  11 , David W Ray  12 , Graham P Leese  13 , Thomas Hugh Jones  14 , Prakash Abraham  15 , Ashley Grossman  16 , Aled Rees  17 , Salman Razvi  18 , Fraser W Gibb  19 , Carla Moran  20 , Asgar Madathil  21 , Miloš P Žarković  22 , Zoe Plummer  23 , Sheba Jarvis  6 , Agnieszka Falinska  6 , Anand Velusamy  9 , Violet Sanderson  16 , Nadia Pariani  20 , Stephen L Atkin  24 , Akheel A Syed  25 , Thozhukat Sathyapalan  24 , Sath Nag  26 , Jackie Gilbert  27 , Helena Gleeson  28 , Miles J Levy  28 , Colin Johnston  29 , Nigel Sturrock  30 , Stuart Bennett  21 , Biswa Mishra  31 , Isha Malik  31 , Niki Karavitaki  16
Affiliations
Observational Study

Postradioiodine Graves' management: The PRAGMA study

Petros Perros et al. Clin Endocrinol (Oxf). 2022 Nov.

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.

PubMed Disclaimer

References

REFERENCES

    1. Smith TJ, Hegedus L. Graves' disease. N Engl J Med. 2017;376(2):185.
    1. Ross DS, Burch HB, Cooper DS, et al. American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343-1421.
    1. Weetman T. The use of radioiodine in the management of benign thyroid disease. Clin Med. 2007;7(3):214-215.
    1. Bonnema SJ, Hegedus L. Radioiodine therapy in benign thyroid diseases: effects, side effects, and factors affecting therapeutic outcome. Endocr Rev. 2012;33(6):920-980.
    1. Kahaly GJ, Bartalena L, Hegedus L, Leenhardt L, Poppe K, Pearce SH. European Thyroid Association guideline for the management of Graves' hyperthyroidism. Eur Thyroid J. 2018;7(4):167-186.

Publication types