Dr Earn Gan, consultant endocrinologist, Newcastle

Research project: Does persisting thyroid inflammation explain poor quality of life after radioiodine therapy (RAI)?

Photo of Earn Gan. Earn is South East Asian, has her hair in a short bob and wears glasses. Title reads BTF Research Award 2023 winner - Dr Earn Gan, consultant endocrinologist.

‘Thank you to the BTF and I am hugely grateful for the award. This project aims to demonstrate the presence of thyroid and systemic inflammation in Graves’ disease patients after RAI treatment and whether this correlates with impaired Quality of Life (QoL). We hope to develop possible interventions that would help prevent poorer QoL in Graves’ disease patients after RAI treatment’. Dr Earn Gan, 

Healthcare professionals and researchers recognise that radioiodine therapy can cause thyroid antibodies to rise and TSH-receptor antibodies to worsen in up to 73% of treated patients. This is in contrast to patients treated with antithyroid medication or surgery whose thyroid antibody levels gradually decline and disappear over time. 

We are pleased to support Dr Gan’s study with our 2023 BTF Research Award. This will provide £35,000 to allow her to investigate whether raised antibody levels in RAI-treated patients have an influence on the poor quality of life many report post-treatment. This three-year study will build on Newcastle University’s strong record of thyroid research, which has a particular focus on autoimmune thyroid disorders and thyroid cancers.

We asked Dr Gan about her proposed study:

What is the background to your study?

Graves’ disease is one of the most common autoimmune conditions. It affects around 3% of women and 0.5% of men. Graves’ disease is treated with either RAI, antithyroid drugs or surgery.

In this condition the immune system turns against the thyroid gland, making it overactive. During the process, the immune system produces proteins called thyroid autoantibodies. These autoantibodies disappear after thyroid surgery but persist for many years in more than 50% of patients receiving RAI for Graves’ disease. 

RAI is a highly effective method of treatment for Graves’ disease (GD) and doctors now offer it as the first-line definitive treatment. It works by destroying the cells in the thyroid gland. This reduces the amount of thyroid hormones produced but also releases thyroid protein fragments into the blood. This could result in a new immune response against these thyroid proteins and generate or worsen thyroid inflammation in some patients. This is consistent with the high level of blood autoantibodies that are already known to occur following radioiodine treatment. The presence of persisting thyroid inflammation has the potential to cause ongoing symptoms of fatigue, brain fog and muscle aches and pains, and these issues are known to occur in rheumatic diseases owing to joint inflammation, as well as in people with tumour inflammation caused by cancer.

Why is the study needed?

A 2019 study by Dr Torring and colleagues observed that patients who received radioiodine therapy for GD have a worse quality of life 6 to 10 years later, compared with people treated with thyroidectomy surgery. The reasons for this are not obvious.

Understandably, this study and other reports have raised concerns among some patients and have put them off having radioiodine treatment. While one of the causes of having worse quality of life following radioiodine therapy could be under-replacement with levothyroxine, researchers have not yet investigated the effects of the radiation damaging the thyroid and producing inflammation, which is reflected partly by persisting thyroid autoantibodies in the blood.

What will your study do?

We will perform a clinical study to investigate whether persistent thyroid inflammation explains poor quality of life after radioiodine therapy in Graves’ disease. This is an important question as if this concept is proven, medication to reduce inflammation such as a short course of steroid tablets, which are readily available, might improve the outcome of patients receiving radioiodine therapy. This form of treatment has been proven to work to prevent eye inflammation (thyroid eye disease) post-RAI.

How will you conduct the study?

We will recruit 20 patients treated with radioiodine therapy and 10 with thyroid surgery. We will use blood tests, two sets of quality-of-life questionnaires and thyroid PET scans to study the relationship between thyroid inflammation and quality of life. We will test blood for thyroid autoantibodies, blood markers of inflammation and measure the small proteins involved in inflammation and immune processes (cytokines).

Participants will visit us three times in total; at the start (baseline), at six months and at 12 months. Ten of the 20 patients treated with RAI will have PET scans at baseline and at 12 months. 

What will the BTF Research Award fund?

The Award will pay for regular blood tests and PET scans in patients participating in the study.

When will the study start?

We will run the study over a three-year period and will begin recruiting in summer 2024. 

How can patients get involved?

We will be recruiting patients from our ‘Benign Thyroid Disease Clinic’ at the Royal Victoria Infirmary here in Newcastle and patients from the regional hospitals. We will also advertise details of how patients can enrol to the study on the BTF’s website.

What potential does your study have for Graves’ disease patients?

Our findings will provide key information for future studies to look into ways to reduce the risk of poor quality of life in patients receiving RAI for Graves’ disease.

We also hope that by increasing our understanding of any less favourable outcomes linked with treatments, we can help patients to make informed choices based on the best-available evidence.

Thank you

Our BTF Research Award has been made possible thanks to the generous response to our BTF Research Appeal. Our supporters raised an incredible £17,500. A grant from the Robert Luff Foundation boosted our funds further meaning we could offer a total of £35,000 for a three-year study. Thank you to everyone who has supported our appeal to fund vital thyroid research.

Read about past BTF Research Award-funded studies

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