Relationship Between Graves' Ophthalmopathy and Type of Treatment of Graves' Hyperthyroidism

Abstract

The relationship between the treatment of Graves' hyperthyroidism and the course of ophthalmopathy is rather unclear. Antithyroid drugs may improve eye manifestations, possibly by restoring normal thyroid function and reducing orbit-directed autoimmune reactions, whereas ophthalmopathy may worsen after radioiodine administration or thyroidectomy. This might occur because of a treatment-related release of thyroid antigens and activation of the autoimmune response that might involve the orbit. On the other hand, some authors suggest that complete thyroid ablation, either by radioiodine or surgery, might be beneficial for ophthalmopathy. However, reported effects of radioiodine and thyroidectomy on Graves' ophthalmopathy are conflicting. This may be due, at least in part, to the retrospective feature of most studies and the lack of precise evaluation of ocular involvement. Two prospective studies were performed in which patients with Graves' disease with mild or no ophthalmopathy were randomly assigned to treatment by radioiodine or subtotal thyroidectomy alone or in association with systemic glucocorticoids. Both treatments were followed by a progression of pre-existing mild ophthalmopathy in a substantial proportion of cases: glucocorticoids prevented such an exacerbation. Ophthalmopathy did not develop in patients without clinical evidence of eye disease prior to therapy. Therefore, it is recommended that a course of glucocorticoids be instituted concomitantly with radioiodine therapy or thyroidectomy in Graves' patients with some degree of ocular involvement.

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

“…Is there a relationship between the modality of treatment for hyperthyroidism and the course of GO? † Antithyroid drug (ATD) therapy (27,30,33) and thyroidectomy do not affect the course of GO (26,(34)(35)(36), although the role of the latter requires further investigation. † No particular ATD or regimen, nor any type of thyroidectomy (subtotal or total) has been demonstrated to have any advantages in terms of outcome of GO.…”

An update on thyroid-associated ophthalmopathy in children and adolescents

“…Therefore, close cooperation between ophthalmologists and endocrinologists is extremely important. In treatment of hyperthyreosis, in course of Graves' disease, antithyroid drugs are frequently administered and their use often causes improvement in ocular condition [49]. Radioiodine is another treatment option for hyperthyreosis, but it is contraindicated in children aged < 5 years because of the potentially higher risk of developing thyroid cancer [50].…”

Graves' ophthalmopathy: a preventable disease?

“…The view that radioiodine treatment may be responsible for the progression of the ophthalmopathy is not shared by all authors (25), mostly on the basis of results of retrospective and uncontrolled studies (26).…”