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Relapsed Graves with Ophthalmopathy — RACP Adult Medicine MCQ

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HardEndocrinologyRelapsed Graves with OphthalmopathyRACP Adult Medicine

A 60-year-old woman with Graves disease has relapsed after two 18-month courses of carbimazole. She has moderate Graves ophthalmopathy (diplopia, proptosis). She declines surgery. What is the most appropriate definitive treatment?

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Correct answer: C — Total thyroidectomy

Relapsed Graves disease after two courses of ATD requires definitive treatment. RAI is relatively contraindicated with moderate-severe Graves ophthalmopathy (risk of GO worsening). Total thyroidectomy is the preferred definitive option when GO is present, as it removes the thyroid antigen source. Steroid cover with RAI can mitigate GO risk, but surgery is safer for significant ophthalmopathy.

Reference: ESA – 2024 – Thyroid; ETA 2018 Graves; EUGOGO 2021 GO