British Thyroid Association Survey of Graves' Disease Management in the UK

Background

Recent years have seen changes and uncertainties in evidence and guideline recommendations in Graves' disease treatment. To understand the impact of these developments on current practice, we undertook a survey of Graves' disease management in the United Kingdom and compared this to other national and international surveys.

Method

Members of the British Thyroid Association, the UK Society for Endocrinology and regional endocrinology networks, were invited by e-mail to complete a 15-min online survey (October 2022 to March 2023).

Results

Out of 158 eligible respondents, 99% were endocrinologists. For a 40-year-old female with a first presentation of Graves' hyperthyroidism, TSH-receptor antibodies (TRAb) were requested at diagnosis and at follow-up by 95% and 76%, respectively. Isotope scans and ultrasound were rarely requested (< 5%). Majority (95%) would treat with antithyroid drugs (ATD), predominantly Carbimazole (CMZ), while radioactive iodine (RAI) was preferred for recurrent disease (81%). Common reasons for avoiding RAI were thyroid eye disease, pregnancy intention, or contact with young children whereas biochemical severity, goitre, or male sex did not influence decision to use RAI. Propylthiouracil (PTU) was preferred in preconception and early pregnancy, but after the first-trimester, 50% would continue PTU while 50% switch back to CMZ.

Conclusions

The survey confirms a growing application of TRAbs, both for diagnostic and prognostic purposes. ATDs remain the preferred first-line therapy for Graves' disease, which is consistent with global trends but contrary to National Institute of Health and Care Excellence (NICE) guidance. Further studies are required to explore the clinical and pragmatic determinants of current treatment approaches.