Treatment of Graves' disease and the course of ophthalmopathy
Abstract
Purpose Contradictory results have been obtained with regards to the effect of various treatment modes on the exacerbation of Graves' ophthalmopathy, probably because the number of patients in each study was small and some studies were analyzed only in relation to one type of treatment. To circument these problems, we studied the course of Graves' ophthalmopathy after various modes of therapy for thyrotoxicosis among 537 patients with Graves' disease.Patients and methods A total of 537 patients with Graves' disease were prospectively studied over an 11-year period. Thirty-one patients were lost to follow-up during the first six months after treatment and were excluded from the study. Of those remaining, 426 received one form of treatment, 79 received two kinds of therapy, and one received three kinds of therapy. Thus, surgical treatments numbered 164, radioactive iodine-131 (131I) treatments numbered 241, and medical treatments numbered 182. Ocular signs were considered improved or exacerbated by the following criteria: decrement or increment of the exophthalmos of 2 mm or more, improvement or deterioration of visual acuity, and regression or progression of extraocular muscle involvement causing diplopia.Results Among patients who did not have infiltrative ophthalmopathy before treatment, there was no difference in the occurrence of posttreatment exophthalmos in the surgically, medically, and 131I-treated patients (7.1%, 6.7%, and 4.9%, respectively). The incidence and the degree of progression of ophthalmopathy in patients who already had exophthalmos before treatment were similar in the medically, surgically, and 131I-treated groups (19.2%, 19.8%, and 22.7%, respectively). Most of the progression occurred in the posttreatment euthyroid stage. The incidence of improvement of ophthalmopathy was also similar (14.1%, 12.6%, and 12.3% in the medically, surgically, and 131I-treated patients).Conclusion In conclusion, we found no influence of type of therapy for thyrotoxicosis on the clinical course of Graves' ophthalmopathy in this retrospective study of 537 patients.
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One prospective but nonrandomized cohort study identified no difference among ATD, surgery, and RAI treatment, with an overall 4.9%-7.1% frequency of GO development.
“In contrast, one prospective but nonrandomized cohort study identified no difference among ATD, surgery, and RAI treatment, with an overall 4.9%-7.1% frequency of GO development (541).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [541]
Two early nonrandomized studies found no differences between the three GD therapeutic modalities.
“Two early nonrandomized studies found no differences between the three GD therapeutic modalities (541,545).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [541]
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- Authors
- Sridama, V., & DeGroot, L. J.
- Affiliations
- University of Chicago (US)
- Corresponding author
- DeGroot, Leslie J.
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 1989-07
- Volume
- 87
- Issue
- 1
- Pages
- 70-73
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2077973993
- Cited by
- 137
- References
- 22
- Citations by year
- 2023: 1 · 2020: 2 · 2018: 1 · 2017: 1 · 2016: 3 · 2015: 5 · 2014: 5 · 2013: 2 · 2012: 4
- FWCI
- 7.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (AM27384)
- National Center for Research Resources
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- Graves' disease, Graves' ophthalmopathy, thyroidectomy, antithyroid drug therapy, proptosis, diplopia, extraocular muscle involvement, visual acuity
- MeSH terms
- Adult, Diplopia, Female, Follow-Up Studies, Graves Disease, Humans, Iodine Radioisotopes, Male, Middle Aged, Prospective Studies, Retrospective Studies, Vision Disorders
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