Endocrine Abstracts

The use of anti-thyroid medication is favoured first line therapy in Graves’ disease (GD). However, relapse rates are high (up to 50%) and definitive therapies of either surgery or radioactive Iodine therapy (RAI) are often considered following an informed decision. The definitive choice taken depends on several factors considered during the patient-doctor interaction. The aim of this study was thus to determine the influence of such factors.

A cross-sectional, qualitative study using a questionnaire based interview approach was used. 14 participants with relapsed GD were recruited at an endocrinology clinic in East Kent. This involved ranking a series of statements from ‘strongly agree’ to ‘strongly disagree’ exploring the effect of relatives, doctors, patient knowledge, co-morbidities and misconceptions around RAI. The results are expressed in percentages.

RAI was favoured by 71% of our subjects, surgery by 7%, with others uncertain of their choice. Only 50% of patients could correctly recall the advantages and disadvantages of surgery vs RAI. 14% of patients confessed being frightened by RAI and expressed concerns over continued radioactivity. All (100%) patients disclosed that their relatives would play no part in their decision making process with 78% willing for their doctor to make that final decision for them. The patients’ age (above 65 years – 50%) and presence of co-morbidities (14%) were most likely to influence a patient to choose RAI while surgical patients were likely to be younger (50%) and have no other medical conditions (78%).

This study highlights the need to fully clarify to relapsed GD patients the pros and cons of each definitive therapy. Clinicians can be reassured that misconceptions surrounding RAI are low and that in the majority of cases it is the favoured treatment choice. We conclude that the most influential factors considered by relapsed patients were their age and the presence of co-morbidities.