Radioiodine Therapy of Graves' Hyperthyroidism in Patients Without Pre-existing Ophthalmopathy: Can Glucocorticoids Prevent the Development of New Ophthalmopathy?

Abstract

The risk of new GO in the first year after RIT was low and the clinical course of GO was mild when RIT was combined with a low-dose glucocorticoid regimen. Preventive administration of glucocorticoids can therefore be recommended in patients with Graves' disease even without evident GO.

Greater Efficacy of Total Thyroidectomy versus Radioiodine Therapy on Hyperthyroidism and Thyroid-Stimulating Immunoglobulin Levels in Patients with Graves’ Disease Previously Treated with Antithyroid Drugs

“…However, the difference between both groups did not remain significant, likely because our study was not designed and powered enough to specifically address this question. It is now well established that worsening of GO may occur after RAI administration [6,7,8,9], but there is no clear consensus about the need for prophylactic use of glucocorticoids when RAI has to be given to patients with preexisting GO [25,26]. Some advocate steroid administration only in the presence of risk factors such as smoking, high TSI levels, severe preexisting GO or high levels of FT 3 before treatment [8,24,27].…”

Bipolar Radiofrequency Ablation for Nodular Thyroid Disease—Ex Vivo and In Vivo Evaluation of a Dose-Response Relationship

“…In the Whickham survey, thyroid nodules were estimated to be present in 5.3% of women and 0.8% of men [5]. Surgery and radioiodine therapy are the established methods for therapy of functional thyroid disease, as well as benign or malignant lesions of the thyroid gland [3,6,8,9]. In patients with high surgical risk, the treatment of local or distant recurrence of thyroid carcinoma with scanty uptake of iodine 131 is problematic, and the therapeutic strategy for the debulking of hypofunctioning nodules that cause compressive symptoms is still unsatisfactory [10].…”

Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO

“…O Good practice point recommended by consensus development group. † The risk of exacerbation of pre-existing GO following radioiodine therapy is negligible and steroid cover can be avoided in patients with inactive eye disease, as long as post-radioiodine hypothyroidism is avoided (37,38), and other risk factors for GO progression, including smoking (28) and high thyrotrophin receptor antibody levels (O7.5 IU/l) (39), are absent (40).…”