Thyroid-Associated Ophthalmopathy after Treatment for Graves’ Hyperthyroidism with Antithyroid Drugs or Iodine-131

• Published in: The journal of clinical endocrinology and metabolism Vol. 94; no. 10; pp. 3700 - 3707
• Main Authors: Träisk, Frank, Tallstedt, Leif, Abraham-Nordling, Mirna, Andersson, Tommy, Berg, Gertrud, Calissendorff, Jan, Hallengren, Bengt, Hedner, Pavo, Lantz, Mikael, Nyström, Ernst, Ponjavic, Vesna, Taube, Adam, Törring, Ove, Wallin, Göran, Åsman, Peter, Lundell, Göran
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01.10.2009
• Subjects: Adult; Aged; Antithyroid Agents - therapeutic use; Biological and medical sciences; Clinical Medicine; Disease Progression; Endocrinology and Diabetes; Endocrinopathies; Endokrinologi och diabetes; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Graves Ophthalmopathy - diagnosis; Graves Ophthalmopathy - drug therapy; Graves Ophthalmopathy - etiology; Humans; Hyperthyroidism - complications; Hyperthyroidism - diagnosis; Hyperthyroidism - drug therapy; Iodine Radioisotopes - therapeutic use; Kaplan-Meier Estimate; Klinisk medicin; Male; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Proportional Hazards Models; Risk Factors; Thyroid. Thyroid axis (diseases); Thyrotropin - blood; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Endocrinopathy; Immunopathology; Obesity; Antithyroid agent; Nutrition; Hyperthyroidism; Thyroid diseases; Nutrition disorder; Autoimmune disease; Metabolic diseases; Treatment; Graves disease; Endocrinology; Nutritional status; Iodine
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/jc.2009-0747

Context: Previous randomized trials have suggested an association between radioiodine treatment for Graves’ hyperthyroidism and thyroid-associated ophthalmopathy (TAO). Objectives: The aim of the study was to compare the occurrence of worsening or development of TAO in patients who were treated with radioiodine or antithyroid drugs. Design: We conducted a randomized trial (TT 96) with a follow-up of 4 yr. Patients, Setting, and Intervention: Patients with a recent diagnosis of Graves’ hyperthyroidism were randomized to treatment with iodine-131 (163 patients) or 18 months of medical treatment (150 patients). Early substitution with T4 was given in both groups. Main Outcome Measure: Worsening or development of TAO was significantly more common in the iodine-131 treatment group (63 patients; 38.7%) compared with the medical treatment group (32 patients; 21.3%) (P < 0.001). Results: The risk for de novo development of TAO was greater in patients treated with iodine-131 (53 patients) than with medical treatment (23 patients). However, worsening of TAO in the 41 patients who had ophthalmopathy already before the start of treatment was not more common in the radioiodine group (10 patients) than in the medical group (nine patients). Smoking was shown to influence the risk of worsening or development of TAO, and smokers treated with radioiodine had the overall highest risk for TAO. However, in the group of smokers, worsening or development of TAO was not significantly associated with the choice of treatment for hyperthyroidism. Conclusions: Radioiodine treatment is a significant risk factor for development of TAO in Graves’ hyperthyroidism. Smokers run the highest risk for worsening or development of TAO irrespective of treatment modality. Radioiodine treatment for Graves’ hyperthyroidism (when compared to anti-thyroid drug treatment),and smoking increase the risk for the development of thyroid associated ophthalmopathy.