Endocrine Abstracts

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.