SFEBES2023 Poster Presentations Thyroid (63 abstracts)
1Department of Ophthalmology, Chelsea and Westminster Hospital, London, United Kingdom. 2Department of Nuclear Medicine, Chelsea and Westminster Hospital, London, United Kingdom. 3Radiation Protection, Kings College Hospital NHS Foundation Trust, London, United Kingdom. 4Department of Endocrinology, Chelsea and Westminster Hospital, London, United Kingdom. 5Imperial College, London, United Kingdom
Graves orbitopathy (GO) development or reactivation is a well-recognised complication of radioactive iodine (RAI), with possible lower incidence in a recent series. We performed a retrospective audit of Graves disease patients treated with RAI at our centre over a 5-year period. We recorded the GO incidence after RAI treatment, risk factors present, and steroid prophylaxis use. Data collected: smoking status, thyroid-stimulating hormone receptor antibody (TRAb), GO history, Graves disease duration, eye features pre- and post-treatment, prophylactic corticosteroids, RAI dose given, post-RAI thyroid status, duration until hypothyroid. 101 patients were included, with median Graves disease duration 36 months. 34/101 (33.7%) were active/ex-smokers, 86/101 (85.1%) were documented 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. 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. Our cohort had a lower GO incidence than historically reported in the literature, but a higher proportion arising de novo. Risk factors identified for de novo thyroid eye disease were very high TRAb levels and short duration from diagnosis to RAI. Changes implemented as a result of this audit include establishment of a Joint Thyroid-Eye clinic to facilitate collaboration between clinicians and appropriate patient selection for RAI referral, ensuring baseline eye assessments are carried out with specialist Ophthalmology input, risk factors are documented/modified where possible, and a holistic approach is taken towards the decision for steroid prophylaxis. Our consent form and patient leaflets have been updated to ensure future patients are well-informed.