Occurrence of Ophthalmopathy after Treatment for Graves' Hyperthyroidism

Tallstedt, Leif; Lundell, G. E. F.; Törring, Ove; Wallin, Göran; Ljunggren, Jan‐Gustaf; Blomgren, Henric; Taube, Adam

doi:10.1056/nejm199206253262603

Cited by 469 publications

(325 citation statements)

References 18 publications

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“…Importantly, patients with higher initial levels of TRAb had a significantly higher risk of severe outcomes upon multiple logistic regression analysis. As GO pathogenesis remains incompletely understood and because there are few clues that are currently available to assist clinicians in estimating the course of GO, [23][24][25][26][27] identifying novel, objectively measurable risk factors that could predict severe GO outcomes are of important scientific and clinical benefit. In patients with high levels of TRAb, it would be reasonable to follow up with these patients and monitor the activity and severity more closely.…”

Section: Discussionmentioning

confidence: 99%

Relevance of TSH-receptor antibody levels in predicting disease course in Graves’ orbitopathy: comparison of the third-generation TBII assay and Mc4-TSI bioassay

Jang

Shin

Lee

et al. 2013

Eye

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Aims To investigate if TSH-receptor antibody (TRAb) levels measured in early Graves' orbitopathy (GO) stages are predictive of clinical disease course beyond 1 year after initial GO diagnosis and to compare performance of two newly developed TRAb assays (third-generation thyrotropin-binding inhibitor immunoglobulin (TBII) assay vs Mc4-thyroid-stimulating immunoglobulin (TSI) bioassay) in predicting disease course. Methods Newly diagnosed, untreated GO patients whose duration of ocular symptoms was less than 6 months were included. One year after initial diagnosis, all patients were classified as presenting either a mild (Group 1) or severe course (Group 2) according to their clinical manifestations. The measurements of two TRAb assays at initial GO diagnosis were used for analysis. Results Data from 112 patients were available for analysis. Seventy-three patients (65.2%) were designated as Group 1, and 39 patients (34.8%) as Group 2. Patients with higher initial TRAb levels demonstrated a higher risk of severe disease course upon multiple regression analysis (Po0.01). The cutoff values for the prediction of severe course of the third-generation TBII and Mc4-TSI assays were 10.67 IU/l and 555.10%, respectively, with assay specificities of 84.9 and 89.0%. The TBII assay predictive power

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Section: Discussionmentioning

confidence: 99%

Relevance of TSH-receptor antibody levels in predicting disease course in Graves’ orbitopathy: comparison of the third-generation TBII assay and Mc4-TSI bioassay

Jang

Shin

Lee

et al. 2013

Eye

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“…In the present patient, severe Graves' ophthalmopathy developed after 131I therapy. Although aggravation of Graves' ophthalmopathy after radioiodine therapy is known (4,5), severe ophthalmopathy is rare in Japan even after radioiodine therapy (38, 39). Therefore, the development of severe ophthalmopathy after radioiodine therapy in the present patient deserves special mention.…”

Section: Discussionmentioning

confidence: 99%

“…About 70% of patients with Graves' disease are treated by this method in the United States (1), and about 20%and 10%receive such therapy in Europe and Japan, respectively (1)(2)(3). Although adverse effects are usually negligible in radioiodine therapy, the developmentor aggravation of Graves' ophthalmopathy has been reported (4,5). Wepresent the case of a patient with HTLV-Iassociated myelopathy (HAM)who developed severe Graves' ophthalmopathy and uveitis after 13 1I therapy for hyperthyroidism.…”

Section: Introductionmentioning

confidence: 99%

Development of Graves' Ophthalmopathy and Uveitis after Radioiodine Therapy for Graves' Disease in a Patient with HTLV-I Associated Myelopathy (HAM).

et al. 1994

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HTLV-I carriers or patients with HTLV-I associated myelopathy (HAM)are prone to immune-mediated inflammatory disorders. Wepresent a 44-year-old female with HAMwho developed Graves' disease. She developed severe Graves' ophthalmopathy shortly after 131I therapy, concurrently with a remarkable increase in TSH-receptor antibody titer. Ophthalmopathy was aggravated in spite of prednisolone therapy and euthyroidism being maintained by thyroxine replacement. Uveitis also developed after 131I therapy and iridocyclitis finally required trabeculotomy. This case suggests that HAM patients may have a higher risk of immune-mediated Graves' ophthalmopathy after 131I therapy. (Internal Medicine 33: 564-568, 1994)

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“…Tallstedt e cols (51), haviam demonstrado em 1992, piora ou aparecimento de oftalmopatia em 33% dos pacientes tratados com radioiodo em comparação com 16 e 10% do grupo tratado com cirurgia ou com DATs; observaram, posteriormente, que a evolução desses pacientes para hipotiroidismo poderia induzir a uma maior exposição antigênica induzida pelo TSH (51). Posteriormente, em trabalho complementar (52) demonstraram que a reposição precoce com T4 reduz a ocorrência de oftalmopatia após emprego de radioiodo.…”

Section: Discussionunclassified

Análise retrospectiva do resultado do tratamento com iodo radioativo em 120 pacientes tirotóxicos por doença de Basedow-graves

Ninno

Esteres

Marone

et al. 1999

Arq Bras Endocrinol Metab

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RESUMOEstudamos retrospectivamente 120 pacientes (96 F/ 24 M) portadores de tirotoxicose por doença de Basedow-Graves submetidos à terapia com iodo radioativo ( 131 I), que receberam inicialmente, para compensação da moléstia, drogas anti-tiroidianas (DAT). A indicação terapêutica posterior de radioiodo deveu-se a uma das seguintes condições clínicas: recidiva após compensação com DAT, falta de compensação devida à baixa aderência às DAT, bócios maiores que 60g, idade avançada ou doença grave associada. As DAT foram suspensas uma semana antes da administração da dose de 131 I, calculada pela fórmula: volume glandular (em g) X radiação efetiva (80 mCi/g de tecido) ¸ captação tiroideana de 24hs. Reavaliamos os pacientes por até 48 meses após a radioiodoterapia. As medianas iniciais de idade, bócio e captação tiroideana de 24hs dos 120 pacientes foram, respectivamente, 34 anos (17-69), 54,5g (20-210) e 73% (21-99). A evolução para hipotiroidismo foi gradual, com 15% dos pacientes a cada 6m até o 18 o mês, seguidos de 2 a 5% dos pacientes a cada 6m até o 48 o mês. O número de pacientes em tirotoxicose decresceu continuamente, representando 52,2% do total inicial após 6m, 25% após 18m e 6,7% após 48m. Ao final, 8 pacientes continuaram em tirotoxicose. O número de pacientes sem tirotoxicose após o tratamento com 131 I, ou seja a soma daqueles em eutiroidismo com aqueles em hipotiroidismo com reposição com T4 (denominada por nós de "cura da tirotoxicose"), alcançou 46,8% dos pacientes em óm, 63,3% em 12m, 81,7% em 24m, 87,5% em 36m e 93,3% em 48m. O número de pacientes que apresentaram hipotiroidismo transitório, ou seja, elevação do TSH acima de 4,5 mU/L até 12m após a dose de 131 I, com normalização posterior, foi 7,5%. Correlacionaram-se positivamente: a) valores iniciais de T3 e ausência de evolução para a cura da tirotoxicose (p=0,02); b) doses totais de 131 I administradas, únicas ou múltiplas, em relação ao tempo de cura da tirotoxicose (p=0,01); c) dose de 131 l/volume glandular em relação ao tempo de cura da tirotoxicose (p=0,02). Os efeitos adversos incluíram exacerbação da tirotoxicose em 3 pacientes e dor na região cervical anterior em um, com reversão dos quadros em todos. Outras duas pacientes engravidaram após o dose terapêutica de 131 I para a tirotoxicose e tiveram gestações sem intercorrência e recém-nascidos normais. (Arq Bras Endocrinol Metab 1999;43/2: 86-95) Unitermos: Tirotoxicose; Radioiodo; 131 I; Doença de Graves; Seguimento ABSTRACTWe studied retrospectively the outcome of radioactive iodine therapy (RAI) in 120 thyrotoxic patients with Graves' disease (96 F/ 24 M) who were primarily treated with anti-thyroid drugs (ATD). The decision to use RAI was due either to relapse after ATD-induced remission, lack of compliance on ATD, goiter larger than 60g, old age or association with severe diseases. ATD were discontinued one week before RAI administration, calculated by the formula: glandular volume (g) vs. effective radiation

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Occurrence of Ophthalmopathy after Treatment for Graves' Hyperthyroidism

Abstract: As compared with other forms of antithyroid therapy, iodine-131 is more likely to be followed by the development or exacerbation of Graves' ophthalmopathy.

Cited by 469 publications

References 18 publications

Relevance of TSH-receptor antibody levels in predicting disease course in Graves’ orbitopathy: comparison of the third-generation TBII assay and Mc4-TSI bioassay

Relevance of TSH-receptor antibody levels in predicting disease course in Graves’ orbitopathy: comparison of the third-generation TBII assay and Mc4-TSI bioassay

Development of Graves' Ophthalmopathy and Uveitis after Radioiodine Therapy for Graves' Disease in a Patient with HTLV-I Associated Myelopathy (HAM).

Análise retrospectiva do resultado do tratamento com iodo radioativo em 120 pacientes tirotóxicos por doença de Basedow-graves

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