Graves’ Orbitopathy Activation after Radioactive Iodine Therapy with and without Steroid Prophylaxis
Abstract
CONTEXT: The reactivation of Graves' orbitopathy (GO) after radioiodine (RAI) for Graves' disease (GD) is a known effect, and its clinical relevance is controversial. Prevention of RAI-induced GO activation is possible in at-risk patients with oral glucocorticoids (OGC). OBJECTIVES: The aim of the study was to analyze the effects of RAI on GO with or without prophylactic steroids based on known risk factors and to compare the effectiveness of prophylaxis with iv glucocorticoids (IVGC) and OGC. DESIGN: We conducted a retrospective study in which patients were assessed before and 1-12 months after RAI. PATIENTS AND SETTING: A total of 113 patients were included in the study; 83 underwent RAI without prophylactic steroids for the absence of risk of activation, and 30 were treated with either OGC (n = 21) or IVGC (n = 9). MAIN OUTCOME MEASURES: We analyzed the prevalence of GO activation with or without steroid prophylaxis and the difference in the prevalence of GO activation after OGC or IVGC. RESULTS: GO activation was observed in 7.2% of patients without and 33.3% of patients with steroid prophylaxis (P < 0.0001), for an overall prevalence of 14.6%. GO activation occurred in 47.6% of patients treated with OGC but in none of the nine patients treated with IVGC (P = 0.0001). Disease activation was more prevalent in males (P < 0.02) and in older patients (P = 0.04) with a shorter duration of GD (P < 0.01) and time from GO onset (P < 0.01). CONCLUSIONS: GO may occur after RAI in approximately 15% of patients also in the absence of signs of active GO. Prophylactic OGC did not prevent GO activation in a large proportion of patients, compared to IVGC.
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In a retrospective study, GO development, deterioration, or reactivation occurred in approximately 7% of patients (6/83) considered at low risk who were given no steroid prophylaxis.
“They identified GO development, deterioration, or reactivation in approximately 7% of patients (6/83) considered at low risk who were given no steroid prophylaxis.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [550]
Only two of these cases had preexistent inactive GO.
“Only two of these cases had preexistent inactive GO.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [550]
Despite prophylaxis, 33% of patients considered at high risk who were treated with oral glucocorticoids had worsening of GO.
“Despite prophylaxis, 33% of patients considered at high risk who were treated with oral glucocorticoids had worsening of GO.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [550]
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“Another study retrospectively examined the effect of concurrent oral or intravenous glucocorticoid therapy on the development or deterioration of preexistent GO after RAI therapy for relapsing GD patients (550).”
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- Authors
- Vannucchi, G., Campi, I., Covelli, D., Dazzi, D., Currò, N., Simonetta, S., Ratiglia, R., Beck-Peccoz, P., & Salvi, M.
- Affiliations
- University of Milan (IT)
- Division of Internal Medicine (D.D.), Ospedale di Fidenza, 43036 Fidenza, Italy
- Ophthalmology (N.C., S.S., R.R.), University of Milan, Fondazione Ospedale Maggiore, Istituto di Ricovero e Cura a Carattere Scientifico, 20122 Milan, Italy
- Departments of Medical Sciences (G.V., I.C., D.C., P.B.-P., M.S.), University of Milan, Fondazione Ospedale Maggiore, Istituto di Ricovero e Cura a Carattere Scientifico, 20122 Milan, Italy
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2009-09-01
- Volume
- 94
- Issue
- 9
- Pages
- 3381-3386
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2021677886
- Cited by
- 92
- References
- 25
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 7 · 2020: 7 · 2019: 5 · 2018: 5 · 2017: 3 · 2016: 10 · 2015: 8 · 2014: 6 · 2013: 5 · 2012: 6
- FWCI
- 4.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Neurology › Myasthenia Gravis and Thymoma
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Keywords
- Graves' ophthalmopathy, Graves' disease, radioiodine therapy, steroid prophylaxis, oral corticosteroids, intravenous glucocorticoids, disease reactivation, risk factors
- MeSH terms
- Administration, Oral, Adolescent, Adult, Aged, Female, Glucocorticoids, Graves Disease, Humans, Injections, Intravenous, Iodine Radioisotopes, Male, Middle Aged, Retrospective Studies, Immunoglobulins, Thyroid-Stimulating, Graves Ophthalmopathy
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