Glucocorticoid administration for Graves' hyperthyroidism treated by radioiodine. A questionnaire survey among members of the European Thyroid Association.
BACKGROUND
Glucocorticoid prophylaxis is required in some instances after radioiodine (RAI) treatment for Graves' hyperthyroidism to prevent progression of Graves' orbitopathy (GO). However, no randomized clinical trial has been performed to ascertain the optimum glucocorticoid therapy.


OBJECTIVE
Aim of this study was to perform a questionnaire-based survey of glucocorticoid prophylaxis among European thyroidologist members of the European Thyroid Association.


RESULTS
Eighty-two responses from 25 European Countries were received. Two respondents did not prescribe steroids in any clinical scenario, while 8 gave the drug to all patients receiving RAI therapy. The majority of respondents only gave glucocorticoids to patients showing some degree of ocular involvement or if risk factors for the progression of GO after RAI were present (e.g., cigarette smoking); 24% of responses indicated that clinicians would not give glucocorticoids if patients were thought to have no GO or inactive GO. Ninety-one percent of clinicians used prednisone (53%) or prednisolone (38%). The mean starting dose [given for 16 days (range 2-60 days)] was 37.6 mg prednisone or prednisone-equivalent (range 15-80 mg). Overall, the results of this survey showed a wide diversity in the regimens used, in terms of timing of initiation of treatment, duration of treatment, cumulative doses of administered glucocorticoids and monitoring of side-effects of glucocorticoid treatment.


CONCLUSIONS
The results of this study underscore the need for randomized clinical trials to ascertain the optimum regimen of prophylactic glucocorticoid therapy.
Lazarus
J H
JH
Centre for Endocrine and Diabetes Sciences, Cardiff University School of Medicine, Cardiff, UK. lazarus@cf.ac.uk
Bartalena
L
L
Marcocci
C
C
Kahaly
G J
GJ
Krassas
G
G
Wiersinga
W M
WM
D005938:Glucocorticoids / Q000627:therapeutic use; D006111:Graves Disease / Q000188:drug therapy*; D049970:Graves Ophthalmopathy / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D006980:Hyperthyroidism / Q000188:drug therapy* / Q000532:radiotherapy; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D011239:Prednisolone / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use
D005938:Glucocorticoids; D007457:Iodine Radioisotopes; D011239:Prednisolone; D011241:Prednisone