Low risk of thyroid eye disease (TED) following radioiodine (RAI) therapy in a multidisciplinary setting: a retrospective cohort study
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Published version
Author(s)
Type
Journal Article
Abstract
Background
Radioiodine (RAI) is recommended by the National Institute of Clinical Excellence (NICE) as a first-line definitive treatment of Grave’s hyperthyroidism (GH). RAI is cited as a major risk factor in the development and exacerbation of thyroid eye disease (TED). We aim to identify the current risk of TED in a population treated post 2015.
Methods
This is a retrospective cohort study including all adult patients diagnosed with GH undergoing RAI over a seven-year period. Data collected included age; gender; thyroid diagnosis and pre- and post-treatment thyroid status; length of GH; TSHR-Ab titres; smoking status; RAI dose and number of treatments; ophthalmology assessment and use of steroid prophylaxis. Investigation results, clinical scoring and management details were collected from patients who developed TED following RAI.
Results
Four of 231 patients (1.7%) treated with RAI over 8 years had new onset (two patients) or progression (two patients) of TED following their RAI. One required immunosuppression and one rehabilitative TED surgery. No patient developed sight-threatening TED.
Conclusions
In our study, judicious screening for high-risk patients and the use of prophylactic steroids results in lower rates of RAI associated TED relative to those reported previously in the literature.
Radioiodine (RAI) is recommended by the National Institute of Clinical Excellence (NICE) as a first-line definitive treatment of Grave’s hyperthyroidism (GH). RAI is cited as a major risk factor in the development and exacerbation of thyroid eye disease (TED). We aim to identify the current risk of TED in a population treated post 2015.
Methods
This is a retrospective cohort study including all adult patients diagnosed with GH undergoing RAI over a seven-year period. Data collected included age; gender; thyroid diagnosis and pre- and post-treatment thyroid status; length of GH; TSHR-Ab titres; smoking status; RAI dose and number of treatments; ophthalmology assessment and use of steroid prophylaxis. Investigation results, clinical scoring and management details were collected from patients who developed TED following RAI.
Results
Four of 231 patients (1.7%) treated with RAI over 8 years had new onset (two patients) or progression (two patients) of TED following their RAI. One required immunosuppression and one rehabilitative TED surgery. No patient developed sight-threatening TED.
Conclusions
In our study, judicious screening for high-risk patients and the use of prophylactic steroids results in lower rates of RAI associated TED relative to those reported previously in the literature.
Date Issued
2025-08-14
Date Acceptance
2025-07-12
Citation
Thyroid Research, 2025, 18
ISSN
1756-6614
Publisher
BMC
Journal / Book Title
Thyroid Research
Volume
18
Copyright Statement
© The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
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Publication Status
Published
Article Number
ARTN 41