Grave's Eye Disease Developing Following Radioiodine Treatment for Toxic Nodular Goitre

Abstract

The development of Grave's ophthalmopathy (GO) following radioiodine (RI) treatment for Grave's thyrotoxicosis, though controversial, is well described. The development of ophthalmopathy following RI treatment for toxic nodular goitre is much less recognised. We report a 49 year-old female patient who developed thyrotoxicosis and GO after receiving RI treatment for toxic nodular goitre and we also review the relevant literature.

Current concepts regarding Graves’ orbitopathy

“…Graves' disease and GO may also be triggered by thyroid damage, including subacute thyroiditis [156][157][158][159], RAI treatment for toxic adenoma/multinodular goiter [160,161], ethanol percutaneous injection for toxic adenoma [162], fine needle aspiration biopsy of thyroid nodules [163], and external radiotherapy in the head and neck region [164,165]-although a recent, large retrospective study of patients who had received neck, craniospinal, or total body irradiation for various tumors found no cases of radiation-induced hyperthyroidism [166]. As for RAI-associated GO progression, the underpinning mechanism is likely the release of thyroid antigens triggering or exacerbating autoimmunity.…”

Grave’s Eye Ophthalmopathy Developing Following Radioiodine Therapy for Toxic Adenoma

“…Van Leussen reported a case similar to our patient, who developed severe Graves' ophthalmopathy, post radioiodine therapy, given for toxic multinodular goiter, necessitating treatment with oral steroids and orbital radiotherapy [18]. It was previously postulated that radioiodine therapy could be inducing the release of TSH receptor antigens into the circulation which in turn would trigger the development of TSH receptor antibody (TRAb) [11][12][13][14][15][16][17].…”

“…The risk of developing severe ophthalmopathy in Graves' disease patients after radioiodine therapy was around 7% [9]. The development of Graves' ophthalmopathy post radioiodine treatment for multi-nodular goiter (toxic or nontoxic) has been rarely described [11][12][13]. Presence of TRAb has been described in 15% -52% of patients with toxic and non-toxic nodular goiter [3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”