Limited English Proficiency and Definitive Management for Graves' Disease

Graves' disease (GD) is the most common cause of hyperthyroidism. Treatment options include antithyroid drugs or definitive management with surgery or radioactive iodine (RAI). Effective counseling is essential, and patients with limited English proficiency (LEP) may face barriers. This study evaluates whether patients' primary language is associated with differences in management type and timing.

We performed a retrospective review of adults treated for GD between January 2018 and September 2024 at our tertiary referral center. Patients were classified as English-proficient (EP) or LEP based on language preference and/or interpreter use. Management strategies included antithyroid drugs, surgery, or RAI. Rates of definitive treatment were analyzed using multivariable logistic regression, and time to treatment was compared using Wilcoxon rank-sum tests.

Among 2416 patients (75.6% female; mean age 47.6 y), 28.2% were LEP. Overall, 8.3% underwent definitive management (160 surgery and 40 RAI). Patients with LEP were older, more likely to have public insurance, and had higher rates of thyroid cancer. Definitive treatment was more common in LEP patients (12.7% versus 6.5%, P < 0.001). LEP patients also had shorter interval from diagnosis to surgery (7.1 versus 11.2 mo, P = 0.038). After multivariable analyses, LEP remained independently associated with definitive management (odds ratio 2.21, 95% confidence interval 1.52-3.22). Sensitivity analyses excluding patients referred for surgery specifically yielded similar results.

Patients with LEP and GD are more likely to receive definitive treatment and experience shorter time from diagnosis to surgery. This association, which is certainly multifactorial, highlights the importance of strategies to enhance shared decision-making in multilingual clinical settings.