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Cited by 129Ophthalmology and Eye DisordersPituitary Gland Disorders and TreatmentsMyasthenia Gravis and Thymoma

Lower Dose Prednisone Prevents Radioiodine-Associated Exacerbation of Initially Mild or Absent Graves’ Orbitopathy: A Retrospective Cohort Study

Lai, Adriana, Sassi, Lorenza, Compri, Emanuele, Marino, Franca, Sivelli, Paolo, Piantanida, Eliana, Tanda, Maria Laura, Bartalena, Luigi·2010·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2009-2130
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Abstract

CONTEXT: Radioiodine (RAI) therapy may cause progression of mild or absent Graves' orbitopathy (GO), preventable by oral prednisone. Optimal doses of prednisone are undefined. OBJECTIVE: The aim of this study was to compare the effectiveness of reported doses [starting dose, >0.3 mg/kg body weight (bw)], and lower (<0.3 mg/kg bw)] doses of prednisone. DESIGN AND SETTING: We conducted a retrospective matched cohort study at a University Center. PATIENTS: Of 111 RAI-treated Graves' patients with mild or no GO, 35 received no steroid prophylaxis (absence of GO and/or risk factors for RAI-associated GO progression); 28 received low-dose prednisone (starting dose, 0.16-0.27 mg/kg bw; mean +/- sd, 0.22 +/- 0.03 mg/kg bw; group 1); and 48 received higher doses (group 2). Among the latter, 28 (starting dose, 0.32-0.56 mg/kg bw; mean +/- sd, 0.36 +/- 0.05 mg/kg bw) were matched with group 1 according to several relevant variables. Prednisone was started 1 d after RAI and withdrawn after 6 wk. MAIN OUTCOME MEASURES: We assessed ocular changes (1, 3, and 6 months after RAI) and side effects of prednisone. RESULTS: Two of 35 patients not receiving steroid prophylaxis (6%) developed mild-to-moderate GO (clinical activity score, 2/7 and 3/7) after RAI. No patients in group 1 or group 2 had GO progression. Side effects were very mild and inconstant, although more frequent in group 2. Both groups showed an increase in bw, an increase that was significantly higher in group 2. CONCLUSION: Lower doses of oral prednisone (about 0.2 mg/kg bw) are as effective as previously reported doses (0.3-0.5 mg/kg bw). A shorter treatment period (6 wk) is probably sufficient. The increase in bw is less using lower doses of prednisone.

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Crossref · 10.1210/jc.2009-2130

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  • A retrospective cohort study suggested that even lower doses and shorter duration of oral prednisone (about 0.2 mg/kg per day for 6 weeks) may be equally effective for prevention of GO exacerbation in patients with initially mild or absent eye disease.

    “However, a retrospective cohort study suggested that even lower doses and shorter duration of oral prednisone (about 0.2 mg/kg per day for 6 weeks) may be equally effective for prevention of GO exacerbation in patients with initially mild or absent eye disease, (544).”

    From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [544]

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Authors
Lai, A., Sassi, L., Compri, E., Marino, F., Sivelli, P., Piantanida, E., Tanda, M. L., & Bartalena, L.
Affiliations
University of Insubria (IT)
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2010-03-01
Volume
95
Issue
3
Pages
1333-1337
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2009-2130
OpenAlex
W2156593644
Cited by
129
References
23
Citations by year
2026: 2 · 2025: 7 · 2024: 3 · 2023: 4 · 2022: 6 · 2021: 8 · 2020: 10 · 2019: 9 · 2018: 6 · 2017: 1 · 2016: 9 · 2015: 15 · 2014: 14 · 2013: 7 · 2012: 12
FWCI
7.36
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • IrInSubria (University of Insubria) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Neurology › Myasthenia Gravis and Thymoma
Keywords
Graves' ophthalmopathy, radioiodine therapy, prednisone, steroid prophylaxis, low-dose prednisone, dose optimization, disease progression, weight gain, matched cohort
MeSH terms
Adult, Aged, Female, Glucocorticoids, Graves Disease, Humans, Sleep Initiation and Maintenance Disorders, Iodine Radioisotopes, Male, Middle Aged, Prednisone, Retrospective Studies, Severity of Illness Index, Thyroid Gland, Thyrotropin, Thyroxine, Triiodothyronine, Weight Gain, Chi-Square Distribution, Statistics, Nonparametric, Graves Ophthalmopathy

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