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Relapsed Graves' disease with orbitopathy — SCE Endocrinology MCQ

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HardThyroidRelapsed Graves' disease with orbitopathySCE Endocrinology

A 35-year-old woman has recurrent thyrotoxicosis 18 months after completing carbimazole for Graves' disease. She has moderate active thyroid eye disease, smokes and has high TSH receptor antibodies. What is the most appropriate management?

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Correct answer: A — Discuss definitive options, favouring surgery if active eye disease makes radioiodine less suitable

Discuss definitive options, favouring surgery if active eye disease makes radioiodine less suitable is best because relapsed Graves' disease warrants definitive therapy discussion, and active orbitopathy plus smoking makes radioiodine less attractive. The alternatives are less appropriate because unprotected radioiodine can worsen eye disease; repeating carbimazole may be considered but should not avoid definitive discussion; levothyroxine worsens thyrotoxicosis; iodine drops do not treat orbitopathy. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG145; European Thyroid Association Graves' orbitopathy guidance