The Dilemma of How to Manage Graves' Hyperthyroidism in Patients with Associated Orbitopathy
Abstract
CONTEXT: Graves' orbitopathy (GO) is present in about 50% of patients with Graves' hyperthyroidism. It may range from mild to moderately severe and (rarely) to sight-threatening. Whether antithyroid drugs (ATDs), radioactive iodine (RAI), or thyroidectomy should be the treatment of choice in the presence of overt and active GO is a matter of debate. EVIDENCE ACQUISITION: The major source of data acquisition included PubMed search strategies. Articles published in the last 30 yr were screened. Furthermore, the bibliographies of relevant citations and chapters of major textbooks were evaluated for any additional appropriate citation. EVIDENCE SYNTHESIS: Prompt restoration and stable maintenance of euthyroidism is important for the course of GO. ATDs and thyroidectomy per se do not influence the natural history of GO. RAI can cause progression or de novo development of GO, particularly in smokers. This effect can be prevented by oral steroid prophylaxis. In patients with mild orbitopathy, the choice of thyroid treatment is largely independent of GO. Moderate-to-severe and active GO should be treated without delay. Whether in these patients, concomitant treatment of hyperthyroidism should be conservative (ATDs) or ablative (RAI, thyroidectomy, or both) is presently based on expert opinion rather than evidence. Emerging and potentially interesting biological agents, such as rituximab, counteracting pathogenic mechanisms of both hyperthyroidism and GO, need to be evaluated in randomized clinical trials. CONCLUSIONS: The choice of the optimal treatment for hyperthyroidism in patients with moderate-to-severe and active GO remains unsettled and is mainly based on personal experience. Randomized clinical trials in this field are eagerly needed.
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Radioiodine treatment may worsen Graves' ophthalmopathy.
“Radioiodine treatment may worsen Graves' ophthalmopathy and is not recommended for patients with active eye disease [123] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [123]
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- Authors
- Bartalena, L.
- Affiliations
- University of Insubria (IT)
- Corresponding author
- Bartalena, Luigi
- ORCID
- Bartalena, Luigi
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2011-03-01
- Volume
- 96
- Issue
- 3
- Pages
- 592-599
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2013383421
- Cited by
- 93
- References
- 63
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 1 · 2019: 5 · 2018: 9 · 2017: 2 · 2016: 9 · 2015: 13 · 2014: 9 · 2013: 10 · 2012: 15
- FWCI
- 1.20
- 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 › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Neurology › Myasthenia Gravis and Thymoma
- Keywords
- Graves' ophthalmopathy, Graves' hyperthyroidism, antithyroid drugs, radioactive iodine, thyroidectomy, steroid prophylaxis, smoking, rituximab, euthyroidism, treatment selection
- MeSH terms
- Graves Disease, Humans, Iodine Radioisotopes, Orbit, Antithyroid Agents, Thyroidectomy, Graves Ophthalmopathy
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