ETA2023 Poster Presentations Hyperthyroidism (9 abstracts)
A prospective, observational study on the effect of an ablative vs a conservative approach for the treatment of graves’ hyperthyroidism in patients with moderate-to-severe, active graves’ orbitopathy
Giada Cosentino 1 , Giulia Lanzolla 2 , Simone Comi 2 , Francesca Menconi 3 , Giovanna Rotondo Dottore 4 , Maria Novella Maglionico 5 , Chiara Posarelli 6 , Michele Figus 6 , Rossella Elisei 7 , Ferruccio Santini 8 & Michele Marinò 9
1University of Pisa, Department of Clinical and Experimental Medicine, Endocrinology, Pisa, Italy; 2University of Pisa, Department of Clinical and Experimental Medicine, Pisa, Italy; 3Endocrinology Unit, University of Pisa, University of Pisa, Department of Clinical and Experimental Medicine, Pisa, Italy; 4Endocrinology Unit, University of Pisa, Department of Clinical and Experimental Medicine, Pisa, Italy; 5Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy.; 6University of Pisa, Ophthalmology Unit I, Department of Surgical, Medical and Molecular Pathology, Pisa, Italy; 7Oncology Section of the Endocrine Unit, Department of Clin and Exp Medicine, University Pisa, Pisa, Italy; 8Dipartimento DI Endocrinologia, University de Pisa, Pisa, Italy; 9Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy., Department of Clinical and Experimental Medicine, Pisa, Italy
Objectives: Optimal treatment for Graves’ hyperthyroidism (GH) in patients with moderate-to-severe, active Graves’ orbitopathy (GO) remains to be established. There is debate on whether a conservative (antithyroid drugs, ATDs) or an ablative approach (radioactive iodine, RAI, or surgery, Tx)has to be preferred. The aim of the present study was to investigate whether these different approachesresult in a different outcome of GOfollowing intravenous glucocorticoids (ivGCs).
Methods: The study design entailed enrollment of 52 consecutive patients with relatively recent onset (≤ 18 mo.) GH and moderate-to-severe, active GO. Following adequate counseling, patients were asked to freely choose between an ablative (RAI for ultrasound thyroid volume ≤ 30 ml, Tx for volume >30 ml) or a conservative approach, to be then treated with ivGCs (12 weekly infusions of methylprednisolone; cumulative dose: 4.5 g). Primary outcome was the overall outcome of GOat 24 weeks (composite evaluation). Secondaryoutcomes were: 1) outcome of single eye features: 2) quality of life (GO-QoL); 3) GO worsening at 24 weeks.
Results: Of 52 patients enrolled, 48 completed the 24-week evaluation, 23 in ablation group (22 treated with RAI and one with Tx) and 25 in ATDs. The two groups did not differ for baseline parameters (sex, age, smoking habits, BMI, thyroid volume, thyroid function, LDL-cholesterol, GO features, TSH-receptor autoantibodies and GO-QoL). The proportion of overall GO responders at 24 weeks was greater in ablation group (47.8% vs 16% in ATDs; OR 4.81; 95% CI from 1.25 to 18.5; P = 0.028). There was a trend to a greater proportion of proptosis, clinical activity score (CAS) and eye duction responders in ablation group, although the difference did not reach significance. On the same line, there was a trend to a greater proportion of GO-QoLresponders in ablation group. Only one patient (4.3%) worsened in ablation group compared with 3 (12%) in ATDs, with no statistical difference. Forty-eight mild adverse events (20 in ablation and 28 in ATDs group) in 36 patients (16 in ablation and 20 in ATDs group) were recorded, of which 19 related to ivGCs and 14 related to thyroid treatment (6 in ablation and 8 in ATDs group), with no difference between groups.
Conclusions: An ablative approach for GHtreatment seems to result in a better overall outcome of GOfollowing ivGCs, without a greater proportion of GO worsening. Further, randomized clinical trials are needed to confirm our observations.
Volume 92
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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