Skip to main content
SpringerLink
Log in

Association between radioiodine therapy for Graves’ hyperthyroidism and thyroid-associated ophthalmopathy

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

To investigate the role of radioactive iodine (RAI) in the onset and progression of thyroid-associated ophthalmopathy (TAO). Forty-six Graves’ disease patients with mild or no ophthalmopathy were prospectively treated with carbimazole (CBZ) (n = 22) or RAI (n = 24). Treatment effects were evaluated clinically over 12 months, and with orbital MRI-measured extra-ocular muscle (EOM) volumes at baseline and at 6 months. The diagnosis of TAO was based on the clinical activity score (CAS) system. There were 11/22 CBZ and 10/24 RAI patients with active ophthalmopathy at baseline. Despite greater mean TSH levels post-RAI (P = 0.003), there was no increase in the likelihood of developing active ophthalmopathy (OR 0.95; 95% CI 0.56–1.61, P = 0.9) or EOM dysfunction (OR 0.52; 95% CI 0.26–1.06, P = 0.074). The increased mean palpebral aperture post-RAI (P = 0.023) and greater mean proptosis in the CBZ group (P = 0.005) were not confirmed when the absolute values of these measurements were examined. There was no association between the treatment received and MRI-measured EOM volumes. In this study, RAI therapy for Graves’ disease did not increase the risk of progression or development of ophthalmopathy in patients with mild or no eye disease at baseline.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Burch HB, Wartofsky L (1993) Graves’ ophthalmopathy: current concepts regarding pathogenesis and management. Endocr Rev 14:747–793

    CAS  PubMed  Google Scholar 

  2. Tallstedt L, Lundell G, Torring O et al (1992) Occurrence of ophthalmopathy after treatment for Graves’ hyperthyroidism. The Thyroid Study Group. N Engl J Med 326:1733–1738

    Article  CAS  PubMed  Google Scholar 

  3. Bartalena L, Marcocci C, Bogazzi F et al (1998) Relation between therapy for hyperthyroidism and the course of Graves’ ophthalmopathy. N Engl J Med 338:73–78

    Article  CAS  PubMed  Google Scholar 

  4. Gorman CA, Offord KP (1998) Therapy for hyperthyroidism and Graves’ ophthalmopathy. N Engl J Med 338:1546–1547

    Article  CAS  PubMed  Google Scholar 

  5. Werner SC, Coelho B, Quimby EH (1957) Ten year results of I-131 therapy of hyperthyroidism. Bull N Y Acad Med 33:783–806

    CAS  PubMed  Google Scholar 

  6. Calissendorff BM, Soderstrom M, Alveryd A (1986) Ophthalmopathy and hyperthyroidism. A comparison between patients receiving different antithyroid treatments. Acta Ophthalmol (Copenh) 64:698–703

    Article  CAS  Google Scholar 

  7. Manso PG, Furlanetto RP, Wolosker AM, Paiva ER, de Abreu MT, Maciel RM (1998) Prospective and controlled study of ophthalmopathy after radioiodine therapy for Graves’ hyperthyroidism. Thyroid 8:49–52

    Article  CAS  PubMed  Google Scholar 

  8. Perros P, Kendall-Taylor P, Neoh C, Frewin S, Dickinson J (2005) A prospective study of the effects of radioiodine therapy for hyperthyroidism in patients with minimally active Graves’ ophthalmopathy. J Clin Endocrinol Metab 90:5321–5323

    Article  CAS  PubMed  Google Scholar 

  9. Sridama V, DeGroot LJ (1989) Treatment of Graves’ disease and the course of ophthalmopathy. Am J Med 87:70–73

    Article  CAS  PubMed  Google Scholar 

  10. Feldt-Rasmussen U, Bech K, Date J, Petersen PH, Johansen K (1982) A prospective study of the differential changes in serum thyroglobulin and its autoantibodies during propylthiouracil or radioiodine therapy of patients with Graves’ disease. Acta Endocrinol (Copenh) 99:379–385

    CAS  Google Scholar 

  11. Bartalena L, Pinchera A, Marcocci C (2000) Management of Graves’ ophthalmopathy: reality and perspectives. Endocr Rev 21:168–199

    Article  CAS  PubMed  Google Scholar 

  12. Pinchera A, Wiersinga W, Glinoer D et al (1992) Classification of eye changes of Graves’ disease. Thyroid 2:235–236

    Article  Google Scholar 

  13. Prummel MF, Bakker A, Wiersinga WM et al (2003) Multi-center study on the characteristics and treatment strategies of patients with Graves’ orbitopathy: the first European Group on Graves’ Orbitopathy experience. Eur J Endocrinol 148:491–495

    Article  CAS  PubMed  Google Scholar 

  14. Wiersinga WM, Perros P, Kahaly GJ et al (2006) Clinical assessment of patients with Graves’ orbitopathy: the European Group on Graves’ Orbitopathy recommendations to generalists, specialists and clinical researchers. Eur J Endocrinol 155:387–389

    Article  CAS  PubMed  Google Scholar 

  15. Kung AW, Yau CC, Cheng A (1994) The incidence of ophthalmopathy after radioiodine therapy for Graves’ disease: prognostic factors and the role of methimazole. J Clin Endocrinol Metab 79:542–546

    Article  CAS  PubMed  Google Scholar 

  16. Villadolid MC, Yokoyama N, Izumi M et al (1995) Untreated Graves’ disease patients without clinical ophthalmopathy demonstrate a high frequency of extraocular muscle (EOM) enlargement by magnetic resonance. J Clin Endocrinol Metab 80:2830–2833

    Article  CAS  PubMed  Google Scholar 

  17. Barth A, Probst P, Burgi H (1991) Identification of a subgroup of Graves’ disease patients at higher risk for severe ophthalmopathy after radioiodine. J Endocrinol Invest 14:209–212

    CAS  PubMed  Google Scholar 

  18. Bartalena L, Marcocci C, Tanda ML et al (1998) Cigarette smoking and treatment outcomes in Graves ophthalmopathy. Ann Intern Med 129:632–635

    CAS  PubMed  Google Scholar 

  19. Karlsson FA, Dahlberg PA, Jansson R, Westermark K, Enoksson P (1989) Importance of TSH receptor activation in the development of severe endocrine ophthalmopathy. Acta Endocrinol (Copenh) 121(Suppl 2):132–141

    Google Scholar 

  20. Kriss JP, Pleshakov V, Rosenblum AL, Holderness M, Sharp G, Utiger R (1967) Studies on the pathogenesis of the ophthalmopathy of Graves’ disease. J Clin Endocrinol Metab 27:582–593

    Article  CAS  PubMed  Google Scholar 

  21. DeGroot LJ, Mangklabruks A, McCormick M (1990) Comparison of RA 131I treatment protocols for Graves’ disease. J Endocrinol Invest 13:111–118

    CAS  PubMed  Google Scholar 

  22. Tallstedt L, Lundell G, Blomgren H, Bring J (1994) Does early administration of thyroxine reduce the development of Graves’ ophthalmopathy after radioiodine treatment? Eur J Endocrinol 130:494–497

    Article  CAS  PubMed  Google Scholar 

  23. Gorman CA (1995) Therapeutic controversies. Radioiodine therapy does not aggravate Graves’ ophthalmopathy. J Clin Endocrinol Metab 80:340–342

    CAS  PubMed  Google Scholar 

  24. Gorman CA (1998) The measurement of change in Graves’ ophthalmopathy. Thyroid 8:539–543

    Article  CAS  PubMed  Google Scholar 

  25. Wiersinga WM (1998) Preventing Graves’ ophthalmopathy. N Engl J Med 338:121–122

    Article  CAS  PubMed  Google Scholar 

  26. Bonnema SJ, Bartalena L, Toft AD, Hegedus L (2002) Controversies in radioiodine therapy: relation to ophthalmopathy, the possible radioprotective effect of antithyroid drugs, and use in large goitres. Eur J Endocrinol 147:1–11

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

 

Funding

The National Health and Medical Research Council of Australia.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Clinical & Biomedical Sciences, Barwon Health, The University of Melbourne, Ryrie Street, PO Box 281, Geelong, VIC, 3220, Australia

    Samer El-Kaissi, Joanne Bowden, Margaret J. Henry, Myra Yeo & Geoffrey C. Nicholson

  2. Department of Medicine, Nepean Hospital, Nepean Clinical School, The University of Sydney, Derby Street, Sydney, NSW, Australia

    Bernard L. Champion & Jack R. Wall

  3. Department of Radiology, Barwon Health, The Geelong Hospital, Ryrie Street, Geelong, VIC, Australia

    Peter Brotchie

Authors
  1. Samer El-Kaissi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joanne Bowden
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Margaret J. Henry
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Myra Yeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernard L. Champion
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter Brotchie
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Geoffrey C. Nicholson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jack R. Wall
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samer El-Kaissi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

El-Kaissi, S., Bowden, J., Henry, M.J. et al. Association between radioiodine therapy for Graves’ hyperthyroidism and thyroid-associated ophthalmopathy. Int Ophthalmol 30, 397–405 (2010). https://doi.org/10.1007/s10792-010-9368-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-010-9368-x

Keywords

Search

Navigation