Effect of Abnormal Thyroid Function on the Severity of Graves' Ophthalmopathy

Prummel, Mark F.; Wiersinga, Wilmar M.; Mourits, Maarten P.; Koornneef, L.; Berghout, A; Gaag, R van der

doi:10.1001/archinte.1990.00390170124027

Cited by 193 publications

(75 citation statements)

References 30 publications

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“…The data available on this issue can be summarized as follows: (1) GO is more severe in patients with untreated hyperthyroidism [39]; (2) the possibility of worsening of GO in patients with GD undergoing radioiodine therapy is greater in those who have received more than one dose of radioiodine [40,41]; and (3) after treatment of hyperthyroidism with a course of anti-thyroid drugs, the possibility of deterioration in the GO is greater in patients who undergo relapse of hyperthyroidism [42]. In theory, these findings could be also interpreted as due to a direct relationship between GO and hyperthyroidism that goes beyond a pathogenetic association of GO with thyroid autoimmunity.…”

Section: Relationship Between Hyperthyroidism Thyroid Treatment and Gomentioning

confidence: 99%

Total thyroid ablation in Graves’ orbitopathy

Menconi

Leo

Vitti

et al. 2015

J Endocrinol Invest

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Graves' orbitopathy (GO) is an autoimmune condition almost always associated with autoimmune thyroid disease, especially Graves' disease (GD). According to the most widely accepted model, the autoantigens responsible for GO would include molecules expressed by thyroid epithelial cells that are present also in orbital tissues. The high likelihood that the etiologies of GO and of the underlying autoimmune thyroid diseases are somehow linked is confirmed by the very close relationship between GO, the onset and the course of Graves' diseases, the size of the thyroid gland, and most importantly, thyroid function and thyroid treatment. Based on these considerations, it has been proposed that complete removal of thyroid antigens and of thyroid infiltrating lymphocytes, the so-called total thyroid ablation (TTA), may be followed by an attenuation of the immune reaction against orbital antigens, and ultimately by an amelioration of GO. The possibility that TTA, achieved by near total thyroidectomy followed by radioiodine, may be beneficial for GO was initially suggested by two retrospective studies and more recently by two prospective, randomized clinical trials conducted in patients with moderate GO treated with intravenous glucocorticoids. Although there seemed to be no difference in the long term, compared with near total thyroidectomy alone TTA was associated with a shorter time required for GO to improve, or anyway to reach its best possible outcome, and with a lesser requirement for additional treatments for GO to improve. Whether this is sufficient to offer ablation to patients remains a matter of discussion. At present, this procedure could be offered only to patients scheduled to thyroidectomy and glucocorticoid treatment.

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Section: Relationship Between Hyperthyroidism Thyroid Treatment and Gomentioning

confidence: 99%

Total thyroid ablation in Graves’ orbitopathy

Menconi

Leo

Vitti

et al. 2015

J Endocrinol Invest

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“…4 Whereas, in the members of the American Thyroid Association, more than two-third prefer radioiodine therapy. 5 It is reported that antithyroid drug treatment is not associated with the development or worsening of pre-existing eye disease, 6 but it would lead to a 20-70% recurrence rate of hyperthyroidism following discontinuation of treatment. [7][8][9][10][11] In contrast, radioiodine therapy is of low remission rate and effectiveness, 11,12 but it might increase the risk of developing or worsening of Graves' ophthalmopathy.…”

Section: Introductionmentioning

confidence: 99%

Radioiodine therapy versus antithyroid drugs in Graves' disease: a meta-analysis of randomized controlled trials

Wang¹,

Lan²

2016

BJR

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Objective: This meta-analysis was performed to compare radioiodine therapy with antithyroid drugs in terms of clinical outcomes, including development or worsening of ophthalmopathy, hyperthyroid cure rate, hypothyroidism, relapse rate and adverse events. Methods: Randomized controlled trials (RCTs) published in PubMed, Embase, Web of Science, SinoMed and National Knowledge Infrastructure, China, were systematically reviewed to compare the effects of radioiodine therapy with antithyroid drugs in patients with Graves' disease. Results were expressed as risk ratio with 95% confidence intervals (CIs) and weighted mean differences with 95% CIs. Pooled estimates were performed using a fixed-effects model or random-effects model, depending on the heterogeneity among studies. Results: 17 RCTs involving 4024 patients met the inclusion criteria and were included. Results showed that radioiodine treatment has increased risk in new ophthalmopathy, development or worsening of ophthalmopathy and hypothyroidism. Whereas, compared with antithyroid drugs, radioiodine treatment seems to have a higher hyperthyroid cure rate, lower recurrence rate and lower incidence of adverse events. Conclusion: Radioiodine therapy is associated with a higher hyperthyroid cure rate and lower relapse rate compared with antithyroid drugs. However, it also increases the risk of ophthalmopathy and hypothyroidism.

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“…It does not suppress the systemic autoimmune process [15]. Cyclosporine may be used as an adjunct or alternative but generally is less effective and has several side effects of its own [30,43]. Periorbital symptoms can be improved by medical treatment.…”

Section: Managementmentioning

confidence: 99%

“…In fact, amelioration or exacerbation of the thyroid disease may not affect the ophthalmopathy [43]. Treatment of hyperthyroidism with radioiodine (I-131) therapy exacerbates TAO in approximately 15% of patients when compared to those patients treated with thionamides or with thyroidectomy [4,48].…”

Section: Managementmentioning

confidence: 99%