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

Some eye changes seen in hyperthyroidism, like lid retraction or stare, result from the increased sympathetic state, and when present without associated eye changes, they are not considered to reflect GO.

“However, some of the eye changes seen in hyperthyroidism, like lid retraction or stare, result from the increased sympathetic state, and when present without associated eye changes, they are not considered to reflect GO (69).”

In two different studies, active smokers who received RAI represented the group with the highest incidence (23%-40%) of new GO or deterioration of pre-existing GO during 1 year of follow-up.

“However, in two different studies, active smokers who received RAI represented the group with the highest incidence (23%-40%) of new GO or deterioration of pre-existing GO during 1 year of follow-up (69,531).”

Smoking is the most important known risk factor for the development or worsening of GO, unrelated to type of therapy for GO, and consistent data from several studies show a detrimental effect of smoking on GO in patients treated with RAI.

“Smoking is the most important known risk factor for the development or worsening of GO, unrelated to type of therapy for GO (535), and consistent data from several studies show a detrimental effect of smoking on GO in patients a ATDs or thyroidectomy are also recommended treatment options in each of these scenarios, and they are the preferred choice of therapy in patients with active and moderate-”

A randomized study of newly diagnosed GD found that RAI followed by active prevention of hypothyroidism by administration of thyroid hormone 2 weeks later did not increase the risk of worsening GO compared to therapy with MMI (relative risk 0.95).

“A randomized study of newly diagnosed GD found that RAI followed by active prevention of hypothyroidism by administration of thyroid hormone 2 weeks later did not increase the risk of worsening GO compared to therapy with MMI (relative risk [RR] of 0.95) (69).”

High pretreatment levels of T3 and T4 were each reported to have a predictive role in GO, but these conclusions were not validated by subsequent studies.

“High pretreatment levels of T 3 and T 4 were each reported to have a predictive role in GO, but these conclusions were not validated by subsequent studies (69,106,532,534), suggesting the possibility of higher TRAb values measured on less sensitive assays early-on being partly responsible for this variation.”

Several randomized trials have identified the risk of GO development or progression after RAI therapy for hyperthyroidism to be between 10% and 39%.

“Several randomized trials have identified the risk of GO development or progression after RAI therapy for hyperthyroidism to be between 10% and 39% (69,540).”

The most recent randomized controlled trial revealed an increased risk for new or worse GO in RAI-treated patients (38.7%) compared with ATD-treated patients (21.3%), mainly related to development of new GO cases, while worsening of preexisting GO occurred at a similar percentage in both groups (45% for RAI and 47% for ATD).

“Finally, the most recent randomized controlled trial (69) revealed an increased risk for new or worse GO in RAI-treated patients (38.7% of the group) compared with ATD-treated patients (21.3% of the group), to be mainly related to development of new GO cases, while worsening of preexisting GO occurred at a similar percentage in both groups (45% for RAI and 47% for ATD).”

Smoking was a strong risk factor for an undesirable GO outcome.

“Smoking was a strong risk factor for an undesirable GO outcome.”