[Anonymous January 15, 1998 at 1:07 am Post count: 93172]

#1052194

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Relation between Therapy for Hyperthyroidism and the Course of Graves’
Ophthalmopathy

Luigi Bartalena, Claudio Marcocci, Fausto Bogazzi, Luca Manetti, Maria
Laura Tanda, Enrica Dell’Unto, Gabriella Bruno-Bossio, Marco Nardi,
Maria Pia Bartolomei, Antonio Lepri, Giuseppe Rossi, Enio Martino, Aldo
Pinchera

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Abstract

Background. The chief clinical characteristics of Graves’ disease are
hyperthyroidism and ophthalmopathy. The relation between the two and the
effect of treatment for hyperthyroidism on ophthalmopathy are unclear.
Methods. We studied 443 patients with Graves’ hyperthyroidism and slight
or no ophthalmopathy who were randomly assigned to receive radioiodine,
radioiodine followed by a 3-month course of prednisone, or methimazole
for 18 months. The patients were evaluated for changes in the function
and appearance of the thyroid and progression of ophthalmopathy at
intervals of 1 to 2 months for 12 months. Hypothyroidism and persistent
hyperthyroidism were promptly corrected.

Results. Among the 150 patients treated with radioiodine, ophthalmopathy
developed or worsened in 23 (15 percent) two to six months after
treatment. The change was transient in 15 patients, but it persisted in
8 (5 percent), who subsequently required treatment for their eye
disease. None of the 55 other patients in this group who had
ophthalmopathy at base line had improvement in their eye disease. Among
the 145 patients treated with radioiodine and prednisone, 50 (67
percent) of the 75 with ophthalmopathy at base line had improvement, and
no patient had progression. The effects of radioiodine on thyroid
function were similar in these two groups. Among the 148 patients
treated with methimazole, 3 (2 percent) who had ophthalmopathy at base
line improved, 4 (3 percent) had worsening of eye disease, and the
remaining 141 had no change.

Conclusions. Radioiodine therapy for Graves’ hyperthyroidism is followed
by the appearance or worsening of ophthalmopathy more often than is
therapy with methimazole. Worsening of ophthalmopathy after radioiodine
therapy is often transient and can be prevented by the administration of
prednisone. (N Engl J Med 1998;338:73-8.)

Source Information

From the Istituto di Endocrinologia (L.B., C.M., F.B., L.M., M.L.T.,
E.D., G.B.-B., E.M., A.P.) and the Clinica Oculistica (M.N., M.P.B.,
A.L.), University of Pisa, and the Reparto di Epidemiologia e
Biostatistica, Istituto di Fisiologia Clinica, National Research Council
(G.R.) — all in Pisa, Italy. Address reprint requests to Dr. Bartalena
at the Istituto di Endocrinologia, University of Pisa, Ospedale
Cisanello, Via Paradisa, 3, 56122 Pisa, Italy.

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