Relation between therapy for hyperthyroidism and the course of Graves' ophthalmopathy.
BACKGROUND
The chief clinical characteristics of Graves' disease are hyperthyroidism and ophthalmopathy. The relation between the two and the effect of treatment for hyperthyroidism on ophthalmopathy are unclear.


METHODS
We studied 443 patients with Graves' hyperthyroidism and slight or no ophthalmopathy who were randomly assigned to receive radioiodine, radioiodine followed by a 3-month course of prednisone, or methimazole for 18 months. The patients were evaluated for changes in the function and appearance of the thyroid and progression of ophthalmopathy at intervals of 1 to 2 months for 12 months. Hypothyroidism and persistent nyperthyroiaism were promptly corrected.


RESULTS
Among the 150 patients treated with radioiodine, ophthalmopathy developed or worsened in 23 (15 percent) two to six months after treatment. The change was transient in 15 patients, but it persisted in 8 (5 percent), who subsequently required treatment for their eye disease. None of the 55 other patients in this group who had ophthalmopathy at base line had improvement in their eye disease. Among the 145 patients treated with radioiodine and prednisone, 50 (67 percent) of the 75 with ophthalmopathy at base line had improvement, and no patient had progression. The effects of radioiodine on thyroid function were similar in these two groups. Among the 148 patients treated with methimazole, 3 (2 percent) who had ophthalmopathy at base line improved, 4 (3 percent) had worsening of eye disease, and the remaining 141 had no change.


CONCLUSIONS
Radioiodine therapy for Graves' hyperthyroidism is followed by the appearance or worsening of ophthalmopathy more often than is therapy with methimazole. Worsening of ophthalmopathy after radioiodine therapy is often transient and can be prevented by the administration of prednisone.
Bartalena
L
L
Istituto di Endocrinologia, University of Pisa, Ospedale Cisanello, Italy.
Marcocci
C
C
Bogazzi
F
F
Manetti
L
L
Tanda
M L
ML
Dell'Unto
E
E
Bruno-Bossio
G
G
Nardi
M
M
Bartolomei
M P
MP
Lepri
A
A
Rossi
G
G
Martino
E
E
Pinchera
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013956:Antithyroid Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018450:Disease Progression; D005094:Exophthalmos / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006111:Graves Disease / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008713:Methimazole / Q000627:therapeutic use*; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome
D013956:Antithyroid Agents; D005938:Glucocorticoids; D007457:Iodine Radioisotopes; D008713:Methimazole; D011241:Prednisone