Ablative Versus Conservative Approach for Hyperthyroidism Treatment in Patients with Graves’ Orbitopathy: A Retrospective Cohort Study
Main finding · Responders, overall GO outcomeResult — go to the resultOdds ratio 6.2 CI 1.6–23.6Authors' conclusion
RAI appears to be associated with an earlier response of GO to intravenous glucocorticoids. In the long term, a conservative approach also seems to be effective. RAI appears to be relatively safe when patients are concurrently treated with glucocorticoids.
Study context
- Population
- Patients with Graves' hyperthyroidism and moderate-to-severe, active Graves' orbitopathy (GO) (EUGOGO guidelines), all given IV methylprednisolone
- Participants
- 49 consecutive patients
- Exposure
- Radioactive iodine (RAI) vs MMI for Graves' hyperthyroidism, with IV methylprednisolone for GO
- RAIn = 24
- MMIn = 25reference
- Outcome
- Overall GO outcome: response = change in ≥2 eye features (CAS reduction ≥1 point; proptosis reduction ≥2 mm; eyelid aperture reduction ≥2 mm; eye ductions increase ≥8 degrees)
- Follow-up
- Week 24
Methodological detailsconsecutive patients, Follow-up 72 weeks in both groups (IQR 66-72 RAI, 48-72 MMI)
- Consecutive patients
- Follow-up 72 weeks in both groups (IQR 66-72 RAI, 48-72 MMI)
Main finding
Responders, overall GO outcome
Odds ratio
6.2
CI 1.6–23.6
P = 0.0075
By group
RAIvs MMI
OR 6.2 (CI 1.6–23.6); P = 0.0075
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | RAI | MMI | OR (CI) | P value | |
|---|---|---|---|---|---|
| GO-specific QoL questionnaire responders · week 24 | 50% | 28% | 2.5 (0.7–8.4) | P = 0.11 | |
| 0.10.31310Odds ratio (log scale) |
Overall GO response · weeks 48 and 72
- Response increased in MMI, with no differences between groups
Individual eye features
- Trend to better response in RAI
GO-specific QoL questionnaire responders · week 24
- Similar in both groups at later time points
Safety
Worsening of GO · week 24
| Outcome | RAI | MMI | OR (CI) | P value | |
|---|---|---|---|---|---|
| Infections | 53.8% | 15.3% | 6.41 (1.7–23.9) | P = 0.0056 | |
| 0.050.21520Odds ratio (log scale) |
Adverse events
- Adverse events recorded, no differences between groups except infections
- 59 among 36 patients
Original publication
Ablative Versus Conservative Approach for Hyperthyroidism Treatment in Patients with Graves’ Orbitopathy: A Retrospective Cohort Study. Thyroid. Published 5 February 2025. doi:10.
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