Nocturnal sleep duration, clinical activity score, and thyroid functional remission after radioactive iodine therapy in Graves’ disease with thyroid-associated ophthalmopathy
- 1Department of Nuclear Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region
Abstract
Objective: To examine whether pretreatment nocturnal sleep duration and Clinical Activity Score (CAS) are associated with thyroid functional remission after radioactive iodine (¹³¹I) therapy in Graves’ disease (GD) with concomitant thyroid-associated ophthalmopathy (TAO). The primary endpoint was thyroid functional remission, not ocular cure.
Methods: We retrospectively reviewed 153 patients at a single center (53 in remission; 100 not in remission), followed for at least 12 months after ¹³¹I therapy. Sleep duration and CAS were pretreatment baseline measures; 20 patients received prednisone before ¹³¹I therapy (discontinued ≥ 3 days prior) and 133 received none; no thyroid-directed or immunosuppressive treatment was given during follow-up. Remission was coded using the response categories of the 2021 Chinese Society of Nuclear Medicine ¹³¹I treatment guideline (euthyroidism or hypothyroidism vs. partial or ineffective response). Missing continuous values were multiply imputed (20 chains). Analyses included false discovery rate (FDR)–controlled univariate screening, cross-validated least absolute shrinkage and selection operator (LASSO) selection, post-selection logistic regression, Firth sensitivity analysis, interaction tests, and mutually adjusted restricted cubic splines (RCS).
Results: No patient sleeping less than 6h achieved remission [0/31; 95% confidence interval (CI) 0%–9.2%]. After FDR adjustment, GD duration, TAO duration, sleep duration, and CAS remained associated with remission. LASSO (one-standard-error rule, C = 0.142) retained GD duration, sleep duration, and CAS. In the post-selection model, the odds ratio (OR) per month of GD duration was 0.991 (95% CI 0.979–1.003; P = 0.152); per additional sleep hour, 6.13 (95% CI 3.16–11.91; P < 0.001; Firth OR 5.64, 95% CI 2.99–10.63); and per CAS point, 0.64 (95% CI 0.48–0.86; P = 0.003). The CAS × sleep interaction was not significant (Wald P = 0.096; likelihood-ratio P = 0.086). Mutually adjusted RCS supported non-linearity for CAS ( P < 0.001) but not for sleep ( P = 0.585).
Conclusions: Longer pretreatment nocturnal sleep and lower CAS were associated with thyroid functional remission after ¹³¹I therapy in this single-center cohort, with consistent directions across sensitivity models. These retrospective, post-selection associations require prospective validation; the absence of remission below 6h and the fitted threshold effects are exploratory post hoc observations, not validated thresholds.
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BibTeX
@article{liao2026nocturnal,
title = {{Nocturnal sleep duration, clinical activity score, and thyroid functional remission after radioactive iodine therapy in Graves’ disease with thyroid-associated ophthalmopathy}},
author = {Kehua Liao and Xiaojuan Wei and Yan Chen and Dongyun Meng and Shaozhou Mo and Zeyong Sun and Fengyang Song and Lu Lu and Wentan Huang},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1954035},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1954035/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Nocturnal sleep duration, clinical activity score, and thyroid functional remission after radioactive iodine therapy in Graves’ disease with thyroid-associated ophthalmopathy
AU - Kehua Liao
AU - Xiaojuan Wei
AU - Yan Chen
AU - Dongyun Meng
AU - Shaozhou Mo
AU - Zeyong Sun
AU - Fengyang Song
AU - Lu Lu
AU - Wentan Huang
PY - 2026
DA - 2026/10/16
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1954035
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1954035/full
AB - Objective: To examine whether pretreatment nocturnal sleep duration and Clinical Activity Score (CAS) are associated with thyroid functional remission after radioactive iodine (¹³¹I) therapy in Graves’ disease (GD) with concomitant thyroid-associated ophthalmopathy (TAO). The primary endpoint was thyroid functional remission, not ocular cure. Methods: We retrospectively reviewed 153 patients at a single center (53 in remission; 100 not in remission), followed for at least 12 months after ¹³¹I therapy. Sleep duration and CAS were pretreatment baseline measures; 20 patients received prednisone before ¹³¹I therapy (discontinued ≥ 3 days prior) and 133 received none; no thyroid-directed or immunosuppressive treatment was given during follow-up. Remission was coded using the response categories of the 2021 Chinese Society of Nuclear Medicine ¹³¹I treatment guideline (euthyroidism or hypothyroidism vs. partial or ineffective response). Missing continuous values were multiply imputed (20 chains). Analyses included false discovery rate (FDR)–controlled univariate screening, cross-validated least absolute shrinkage and selection operator (LASSO) selection, post-selection logistic regression, Firth sensitivity analysis, interaction tests, and mutually adjusted restricted cubic splines (RCS). Results: No patient sleeping less than 6h achieved remission [0/31; 95% confidence interval (CI) 0%–9.2%]. After FDR adjustment, GD duration, TAO duration, sleep duration, and CAS remained associated with remission. LASSO (one-standard-error rule, C = 0.142) retained GD duration, sleep duration, and CAS. In the post-selection model, the odds ratio (OR) per month of GD duration was 0.991 (95% CI 0.979–1.003; P = 0.152); per additional sleep hour, 6.13 (95% CI 3.16–11.91; P < 0.001; Firth OR 5.64, 95% CI 2.99–10.63); and per CAS point, 0.64 (95% CI 0.48–0.86; P = 0.003). The CAS × sleep interaction was not significant (Wald P = 0.096; likelihood-ratio P = 0.086). Mutually adjusted RCS supported non-linearity for CAS ( P < 0.001) but not for sleep ( P = 0.585). Conclusions: Longer pretreatment nocturnal sleep and lower CAS were associated with thyroid functional remission after ¹³¹I therapy in this single-center cohort, with consistent directions across sensitivity models. These retrospective, post-selection associations require prospective validation; the absence of remission below 6h and the fitted threshold effects are exploratory post hoc observations, not validated thresholds.
SN - 1664-2392
ER -