A patient with Graves' disease is started on carbimazole. After 6 weeks, TSH remains suppressed and FT4 is still elevated. The patient asks about definitive therapy. Which statement regarding radioiodine therapy in Graves' disease is CORRECT?
- A It is contraindicated in patients with Graves' ophthalmopathy
- B Post-ablation hypothyroidism occurs in 50–80% within 10 years ✓
- C Pre-treatment with antithyroid drugs prevents radiation thyroiditis
- D It is the preferred definitive treatment in moderate-to-severe active Graves' ophthalmopathy
Correct answer: B. Post-ablation hypothyroidism occurs in 50–80% within 10 years
Explanation
Radioiodine ablation for Graves' disease results in permanent hypothyroidism in approximately 50–80% of patients within 10 years, with the rate increasing over time; this is considered a treatment success rather than a complication. RAI can worsen Graves' ophthalmopathy and is relatively contraindicated (or must be combined with steroids) in active moderate-to-severe ophthalmopathy — thyroidectomy is preferred in that setting. Pre-treatment with antithyroid drugs is stopped before RAI as it reduces efficacy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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