I offer the following as general information and not as specific advice to any individual. It is best to get your info from an endocrinologist regarding treatment options. Surgery is an option but is not offered as frequently because not as many surgeons are trained to do thyroidectomies as before. If you go this route, you need to ask what the surgeon’s experience is and what his or her complication rate has been. RAI is easy but carries risks for your eyes. Approximately 15% of patients who receive RAI will have an exacerbation of their eye disease, be it proptosis, strabismus or eyelid retraction. It can occur even if you don’t currently have thyroid eye disease prior to treatment. However, if you are pre-treated with prednisone (usually 0.5mg/kg body weight/day) beginning the day before treatment and taper the dose over 3-4 weeks, the risk diminishes to approximately 1%. The greatest risk period for onset of eye disease is between 6-12 weeks after RAI although it can occur anytime. The risk is lower with surgical thyroidectomy but surgery carries it’s own risks. Although your eye doctor said you ‘weren’t too bad’ you need careful monitoring, preferably by an oculoplastic ophthalmologist who specializes in this area. I would not rely on an optometrist to monitor you. Most patients do very well with treatment but the beginning can be rocky. I base this on nearly 25 years as an oculoplastic surgeon with a particular interest in Graves disease.
