title: Relation between therapy options for Graves' disease and the course of Graves' ophthalmopathy: a systematic review and meta-analysis.
abstract: BACKGROUND
  The relation between therapy options for Graves' disease (GD) and the course of Graves' ophthalmopathy (GO) are still controversial. Our aim was to compare the occurrence of development or worsening of GO in patients who were treated with antithyroid drugs (ATDs) or radioactive iodine (RAI) or thyroidectomy (TX).
  
  
  METHODS
  We conducted a comprehensive search of the Embase and PubMed database. Odds ratio (OR) was used as a measure of the effect of therapy options for GD on the risk of development or worsening of GO. The analysis was further stratified by factors that could affect the treatment effects.
  
  
  RESULTS
  Nine trials involving 1773 patients were included. RAI therapy showed a significant effect on the risk of development or worsening GO compared with ATD (OR 2.25; 95 % CI 1.61-3.14; P < 0.00001). Glucocorticoid prophylaxis was effective in preventing GO development or worsening (0.40; 0.23-0.68; P = 0.002); especially for patients with preexisting GO (0.41; 0.23-0.73; P = 0.002). At 3 months, showed GO to be improved in 17 TX and 21 total thyroid ablation (TTA) patients, with no significant difference between the two groups; between 6 and 12 months, TTA did show significant beneficial effect on the improvement of GO (6.02; 2.80-12.96; P < 0.00001); GO was found to be inactive in a significantly higher percentage of patients in the TTA (2.17; 1.04-4.52; P = 0.04).
  
  
  CONCLUSIONS
  Radioiodine therapy is a significant risk factor for development or worsening of GO in GD. But GO progression can be prevented by prophylactic glucocorticoids in patients with preexisting GO. Compared with TX alone, TTA induces an earlier and steadier GO improvement in patients with mild to moderate-severe and active GO. Whether this is sufficient to offer TTA to patients needs further investigation.
authors.affiliation: Tianjin Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, China.
authors.forename: H X
authors.initials: HX
authors.lastname: Li
authors.affiliation: Department of Ophthalmology, Tong Ji Hospital, Tong Ji Medical College, Huazhong University of Science and Technology, No. 1095. Jiefang Rd, Hankou District, Wuhan, 430030, China. xiangnan_1111@163.com.
authors.forename: N
authors.initials: N
authors.lastname: Xiang
authors.affiliation: Department of Ophthalmology, Tong Ji Hospital, Tong Ji Medical College, Huazhong University of Science and Technology, No. 1095. Jiefang Rd, Hankou District, Wuhan, 430030, China.
authors.forename: W K
authors.initials: WK
authors.lastname: Hu
authors.affiliation: Tianjin Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, China.
authors.forename: X L
authors.initials: XL
authors.lastname: Jiao
mesh_terms: D049970:Graves Ophthalmopathy / Q000188:drug therapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*
chemical_list: D007457:Iodine Radioisotopes
keywords: Antithyroid drugs; Graves’ disease; Graves’ ophthalmopathy; Radioactive iodine; Thyroidectomy