[Evaluation of radioiodine 131I treatment in Graves' disease patients with mild orbitopathy].
Radioiodine (131I) treatment of patients with Graves-Basedow disease may cause or aggravate the course of orbitopathy (GO) in some 15% of patients; while only 3% of patients treated with methimazole develop GO. The aim of this study was to evaluate the frequency of GO progression in patients with mild GO treated with 131I, compared to a control group.


METHODS
The studied group consisted of 21 hyperthyroid patients (mean age 49 +/- 12.8 years) with mild orbitopathy (CAS < 3 pts, NOSPECS < 4 pts). The control group included 18 hyperthyroid patients with Graves-Basedow disease (mean age 50 +/- 9.9 years) with no GO symptoms (CAS = 0 pts, NOSPECS < 1 pts). All patients were treated with 131I. Patients with GO underwent treatment with oral methyloprednisolone (MP) over 30 days in decreasing doses, commencing with a dose of 16 mg/day. TSH, FT4 and hTRAb serum concentrations were measured prior to, and 14, 30, 60 days and 12 months after administration of 131I, always accompanied by an ophthalmic evaluation.


RESULTS
In the studied group, mean TSH and FT4 concentrations prior to treatment were 0.05 +/- 0.08 microU/ml and 23.7 +/- 10.7 pmol/l, respectively. Mean 131I activity applied in this group was 605.0 +/- 89.0 MBq. No significant differences were stated between values of respective parameters in the studied and control groups. Prior to treatment, median hTRAb concentrations in the studied and control groups were 6.8 U/l (max 53.8, min 0.1) and 8.9 U/l (max 57.1, min 4.2), respectively, and did not differ significantly. After 14 days post commencing MP treatment the median hTRAb concentration in the studied group decreased (4.5 U/l, max 51.1, min 0.1) with respect to the control group (7.5 U/l, max 50.0, min 2.9). After 60 days and 12 months, median hTRAb concentrations in the studied group were 8.3 U/l (max 16.9, min 0.7) and 8.5 U/l (max 9.8, min 3.0) respectively, being higher than those in the control group and also higher than the initial value in studied group. Cured were 16/21 patients in the studied group and 16/18 patients in the control group. Within 12 months observation, progression of GO symptoms in 2 patients (9%) of the studied group was noted and exophthalmos observed in 3 patients (17%) of the control group.


CONCLUSIONS
In patients with mild GO treated with methyloprednisolone 131I administration is effective and does not lead to aggravation of GO symptoms, compared with the control group. Long-term elevation of hTRAb concentration in studied and control group of patients with Graves' disease treated with 131I1 was found.
Bałdys-Waligórska
Agata
A
Katedra i Klinika Endokrynologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków. awalig@cm-uj.krakow.pl
Stefańska
Agnieszka
A
Gołkowski
Filip
F
Sokołowski
Grzegorz
G
Hubalewska-Dydejczyk
Alicja
A
D000906:Antibodies / Q000097:blood; D003131:Combined Modality Therapy; D018450:Disease Progression; D006111:Graves Disease / Q000097:blood / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects*; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D009916:Orbital Diseases / Q000097:blood / Q000209:etiology*; D013972:Thyrotropin / Q000097:blood / Q000276:immunology; D013974:Thyroxine / Q000097:blood
D000906:Antibodies; D007457:Iodine Radioisotopes; D013972:Thyrotropin; D013974:Thyroxine; D008775:Methylprednisolone