Lower Dose Prednisone Prevents Radioiodine-Associated Exacerbation of Initially Mild or Absent Graves’ Orbitopathy: A Retrospective Cohort Study

• Published in: The journal of clinical endocrinology and metabolism Vol. 95; no. 3; pp. 1333 - 1337
• Main Authors: Lai, Adriana, Sassi, Lorenza, Compri, Emanuele, Marino, Franca, Sivelli, Paolo, Piantanida, Eliana, Tanda, Maria Laura, Bartalena, Luigi
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01.03.2010; Copyright by The Endocrine Society
• Subjects: Adult; Aged; Biological and medical sciences; Chi-Square Distribution; Endocrinopathies; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Glucocorticoids - administration & dosage; Graves Disease - pathology; Graves Disease - radiotherapy; Graves Ophthalmopathy - drug therapy; Graves Ophthalmopathy - pathology; Graves Ophthalmopathy - prevention & control; Humans; Iodine Radioisotopes - adverse effects; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Prednisone - administration & dosage; Prednisone - adverse effects; Retrospective Studies; Severity of Illness Index; Sleep Initiation and Maintenance Disorders - chemically induced; Statistics, Nonparametric; Thyroid Gland - drug effects; Thyroid Gland - pathology; Thyroid. Thyroid axis (diseases); Thyrotropin - blood; Thyroxine - blood; Triiodothyronine - blood; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Weight Gain - drug effects; Endocrinopathy; Antineoplastic agent; Orbit (eye) disease; Autoimmune disease; Retrospective study; Radioisotope; Prevention; Cohort study; Graves disease; Dose; Nutritional status; Public health; Iodine; Corticosteroid; Immunopathology; Obesity; Nutrition; Hyperthyroidism; Thyroid diseases; Nutrition disorder; Antiinflammatory agent; Metabolic diseases; Prednisone; Exacerbation; Adrenal hormone; Immunosuppressive agent; Endocrinology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2009-2130

Context: Radioiodine (RAI) therapy may cause progression of mild or absent Graves’ orbitopathy (GO), preventable by oral prednisone. Optimal doses of prednisone are undefined. Objective: The aim of this study was to compare the effectiveness of reported doses [starting dose, >0.3 mg/kg body weight (bw)], and lower (<0.3 mg/kg bw)] doses of prednisone. Design and Setting: We conducted a retrospective matched cohort study at a University Center. Patients: Of 111 RAI-treated Graves’ patients with mild or no GO, 35 received no steroid prophylaxis (absence of GO and/or risk factors for RAI-associated GO progression); 28 received low-dose prednisone (starting dose, 0.16–0.27 mg/kg bw; mean ± sd, 0.22 ± 0.03 mg/kg bw; group 1); and 48 received higher doses (group 2). Among the latter, 28 (starting dose, 0.32–0.56 mg/kg bw; mean ± sd, 0.36 ± 0.05 mg/kg bw) were matched with group 1 according to several relevant variables. Prednisone was started 1 d after RAI and withdrawn after 6 wk. Main Outcome Measures: We assessed ocular changes (1, 3, and 6 months after RAI) and side effects of prednisone. Results: Two of 35 patients not receiving steroid prophylaxis (6%) developed mild-to-moderate GO (clinical activity score, 2/7 and 3/7) after RAI. No patients in group 1 or group 2 had GO progression. Side effects were very mild and inconstant, although more frequent in group 2. Both groups showed an increase in bw, an increase that was significantly higher in group 2. Conclusion: Lower doses of oral prednisone (about 0.2 mg/kg bw) are as effective as previously reported doses (0.3–0.5 mg/kg bw). A shorter treatment period (6 wk) is probably sufficient. The increase in bw is less using lower doses of prednisone. Prednisone is effective in preventing radioiodine-associated progression of Graves’ orbitopathy at doses lower than previously reported.