title: Radioiodine-Associated Exacerbation of Graves' Orbitopathy in the Japanese Population: Randomized Prospective Study.
abstract: BACKGROUND
  Exacerbation of Graves' orbitopathy (GO) after radioiodine (RAI) therapy has been examined in some populations but has not been fully described in Japanese populations.
  
  
  OBJECTIVE
  The purpose of this study was to clarify the characteristics of GO exacerbation after RAI therapy and the effectiveness of low-dose prophylactic corticosteroid (PCS).
  
  
  METHODS
  This was a prospective randomized study in Tokyo, Japan.
  
  
  METHODS
  Between June 2011 and June 2012, 295 patients with Graves' disease with either inactive GO or no GO received RAI therapy. Of these, 147 received no PCS (PCS-Off group), whereas 148 received low-dose PCS (starting dose, 15 mg/day of prednisolone) for 6 weeks (PCS-On group). We used magnetic resonance imaging to thoroughly evaluate GO before and 1 year after RAI therapy.
  
  
  METHODS
  Outcomes of GO 1 year after RAI therapy were determined.
  
  
  RESULTS
  GO exacerbation occurred in 29 patients (9.8%), and only 7 patients (2.4%) required ophthalmic treatment. No significant difference in the frequency of GO exacerbation was seen between the groups (PCS-On group: n = 18 [12.1%]; PCS-Off group: n = 11 [7.5%]; P = .17). Significant prognostic factors were identified as thyroid-stimulating antibody (by 100% linear increase: risk ratio, 1.15; 95% confidence interval, 1.07-1.24; P = .0003) and clinical activity score (≥1 vs 0: risk ratio, 6.40; 95% confidence interval, 2.17-19.7; P = .0009).
  
  
  CONCLUSIONS
  Exacerbation of GO after RAI therapy in the Japanese population appears less common than in other populations. Low-dose PCS did not produce a significant preventive effect and appeared insufficient. Patients presenting with risk factors would thus be recommended to receive higher-dose PCS.
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Natsuko
authors.initials: N
authors.lastname: Watanabe
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Jaeduk Yoshimura
authors.initials: JY
authors.lastname: Noh
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Ai
authors.initials: A
authors.lastname: Kozaki
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Kenji
authors.initials: K
authors.lastname: Iwaku
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sekiya
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kosuga
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Masako
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Miho
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Ai
authors.initials: A
authors.lastname: Yoshihara
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Hidemi
authors.initials: H
authors.lastname: Ohye
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Sakiko
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Yo
authors.initials: Y
authors.lastname: Kunii
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Koji
authors.initials: K
authors.lastname: Mukasa
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Kiminori
authors.initials: K
authors.lastname: Sugino
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Tosyu
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
authors.forename: Koichi
authors.initials: K
authors.lastname: Ito
mesh_terms: D000328:Adult; D000368:Aged; D018890:Chemoprevention; D018450:Disease Progression; D005260:Female; D006111:Graves Disease / Q000188:drug therapy / Q000532:radiotherapy*; D049970:Graves Ophthalmopathy / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects* / Q000627:therapeutic use; D007564:Japan; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D011832:Radiation Injuries / Q000517:prevention & control; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes; D011239:Prednisolone