Endocrine Abstracts

Background: The management of relapsing Graves’ disease is controversial. Previous surveys from different regions in the world demonstrated variations in the clinical practices of patients with Graves’ disease relapse.

Methods: To determine management pattern among endocrinologists in Israel an electronic questionnaire was e-mailed to all members of the Israeli Endocrine Society. Questionnaires included demographic data and clinical scenarios with questions regarding the treatment and follow up of patients with relapsing Graves’ disease.

Results: We received 98 responses from Israeli endocrinologists. 42 (43%) males and 56 (57%) females. 41.8% had board certificate for more than 10 years. 72.4% responders work in hospital environment and 26.5% work in community clinics. 61.2% see more than 10 thyroid patients in clinic per week. When managing Graves’ relapse following ATD treatment in a young male, 68% would restart ATD (98% mercaptizol) and 32% would refer to RAI treatment. Interestingly, endocrinologist who treat more thyroid patients (more than 10/week) tend to choose ATD over RAI (P=0.04). In case of recurrent Graves’ and ophtalmopaty 50% would continue ATD, 22.4% would recommend RAI treatment and 27.6% surgery. Most endocrinologists (56%) would continue ATD for 12–24 months. 75% would monitor CBC and liver function (39% for the first month and 36% for 6 months). 44% would recommend routine neck US, and 19.3% would recommend routine DEXA. In a case of thyrotoxicosis due to 3 cm toxic nodule tirads 4a most endocrinologists (70%) would refer to RAI ablation, 46.4% without FNA and 23.7% with FNA. No significant difference was found in correlation with gender, years of board certificate, or work environment.