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      Relation between Therapy for Hyperthyroidism and the Course of Graves’

      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


      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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