Association between radioiodine therapy for Graves' hyperthyroidism and thyroid-associated ophthalmopathy.
To investigate the role of radioactive iodine (RAI) in the onset and progression of thyroid-associated ophthalmopathy (TAO). Forty-six Graves' disease patients with mild or no ophthalmopathy were prospectively treated with carbimazole (CBZ) (n = 22) or RAI (n = 24). Treatment effects were evaluated clinically over 12 months, and with orbital MRI-measured extra-ocular muscle (EOM) volumes at baseline and at 6 months. The diagnosis of TAO was based on the clinical activity score (CAS) system. There were 11/22 CBZ and 10/24 RAI patients with active ophthalmopathy at baseline. Despite greater mean TSH levels post-RAI (P = 0.003), there was no increase in the likelihood of developing active ophthalmopathy (OR 0.95; 95% CI 0.56-1.61, P = 0.9) or EOM dysfunction (OR 0.52; 95% CI 0.26-1.06, P = 0.074). The increased mean palpebral aperture post-RAI (P = 0.023) and greater mean proptosis in the CBZ group (P = 0.005) were not confirmed when the absolute values of these measurements were examined. There was no association between the treatment received and MRI-measured EOM volumes. In this study, RAI therapy for Graves' disease did not increase the risk of progression or development of ophthalmopathy in patients with mild or no eye disease at baseline.
El-Kaissi
Samer
S
Department of Clinical & Biomedical Sciences, Barwon Health, The University of Melbourne, Ryrie Street, PO Box 281, Geelong, VIC, 3220, Australia. skaissi@hotmail.com
Bowden
Joanne
J
Henry
Margaret J
MJ
Yeo
Myra
M
Champion
Bernard L
BL
Brotchie
Peter
P
Nicholson
Geoffrey C
GC
Wall
Jack R
JR
D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use; D002231:Carbimazole / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006111:Graves Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D049970:Graves Ophthalmopathy / Q000139:chemically induced*; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects* / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000473:pathology; D009915:Orbit / Q000473:pathology; D011446:Prospective Studies; D013960:Thyroid Function Tests; D013972:Thyrotropin / Q000097:blood; D013997:Time Factors
D013956:Antithyroid Agents; D007457:Iodine Radioisotopes; D002231:Carbimazole; D013972:Thyrotropin
N Engl J Med. 1998 May 21;338(21):1546-7
9599113
Endocr Rev. 1993 Dec;14(6):747-93
8119236
N Engl J Med. 1998 Jan 8;338(2):73-8
9420337
Eur J Endocrinol. 2003 May;148(5):491-5
12720530
Thyroid. 1998 Jan;8(1):49-52
9492153
J Clin Endocrinol Metab. 1994 Aug;79(2):542-6
7913934
J Endocrinol Invest. 1990 Feb;13(2):111-8
2329258
J Clin Endocrinol Metab. 2005 Sep;90(9):5321-3
15985483
Thyroid. 1992 Fall;2(3):235-6
1422237
Eur J Endocrinol. 2002 Jul;147(1):1-11
12088914
J Clin Endocrinol Metab. 1995 Feb;80(2):340-2
7852485
J Clin Endocrinol Metab. 1967 Apr;27(4):582-93
6071430
Ann Intern Med. 1998 Oct 15;129(8):632-5
9786811
J Endocrinol Invest. 1991 Mar;14(3):209-12
2071823
N Engl J Med. 1992 Jun 25;326(26):1733-8
1489388
Acta Endocrinol (Copenh). 1982 Mar;99(3):379-85
6896112
Eur J Endocrinol. 2006 Sep;155(3):387-9
16914591
N Engl J Med. 1998 Jan 8;338(2):121-2
9420345
J Clin Endocrinol Metab. 1995 Sep;80(9):2830-3
7673432
Acta Ophthalmol (Copenh). 1986 Dec;64(6):698-703
2433889
Endocr Rev. 2000 Apr;21(2):168-99
10782363
Am J Med. 1989 Jul;87(1):70-3
2741983
Thyroid. 1998 Jun;8(6):539-43
9669294
Bull N Y Acad Med. 1957 Nov;33(11):783-806
13472301
Eur J Endocrinol. 1994 May;130(5):494-7
8180678