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Does early administration of thyroxine reduce the development of Graves' ophthalmopathy after radioiodine treatment?
Abstract
Tallstedt L, Lundell G, Blomgren H, Bring J. Does early administration of thyroxine reduce the development of Graves' ophthalmopathy after radioiodine treatment? Eur J Endocrinol 1994:130: 494–7. ISSN 0804–4643 The roles of thyroid hormones and thryotropin (TSH) in the development of Graves' ophthalmopathy are not clear. Some studies suggest a protective effect of thyroid hormones on experimental exophthalmos and an adverse effect of increased TSH levels. In September 1988 we introduced early thyroxine (T 4) administration after 131 I therapy for hyperthyroidism caused by Graves' disease. We carried out a retrospective study of records from all patients with this disease treated with 131 I for 4 years. During the first 2 years 248 patients were treated (group A). They received T 4 when the serum concentration of TSH and/or T 4 indicated hypothyroidism. During the next 2 years 244 patients were treated (group B). They were all given 0.05 mg of T 4 daily, starting 2 weeks after therapy, and 0.1 mg after a further 2 weeks. With a follow-up of 18 months, 45 patients (18%) in group A and 27 patients (11%) in group B developed or deteriorated in an already present ophthalmopathy (p = 0.03, relative risk = 1.64, 95% confidence interval = 1.05–2.55). Twenty-six patients in group A required specific therapy for the ophthalmopathy (e.g. antithyroid drugs, steroids, etc.) compared to 11 patients in group B (p = 0.02, relative risk = 2.33; 95% confidence interval = 1.18–4.60). Our results suggest that early administration of T 4 after 131 I therapy reduces the occurrence of Graves' ophthalmopathy. L Tallstedt, Department of Ophthalmology, Huddinge University Hospital, S-146 81 Huddinge, Sweden
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In the citing paper
“for GO are listed in Table 15, and the most pertinent ones to this discussion are RAI therapy for hyperthyroidism (531,532), untreated hyperthyroidism, smoking, high serum pretreatment TRAb levels (normal <1.75 IU/L, high risk for progression if >8.8 IU/L) (533), and any delay in treating hypothyroidism after therapy for hyperthyroidism (106,534).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [534]
In the citing paper
“Subsequently, two cohort studies in which patients received levothyroxine therapy early after RAI with the specific intent of preventing hypothyroidism noted that deterioration of GO rarely occurred (0%-2%) (534,536).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [534]
In the citing paper
“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.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [534]
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Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., et al. (2016) · Thyroid® · doi:10.1089/thy.2016.0229 · Cited by 2,938
“Subsequently, two cohort studies in which patients received levothyroxine therapy early after RAI with the specific intent of preventing hypothyroidism noted that deterioration of GO rarely occurred (0%–2%) (534,536).”
BackgroundResultBahn, R. S., Burch, H. B., Cooper, D. S., Garber, J. R., Greenlee, M. C., Klein, I., Laurberg, P., McDougall, I. R., Montori, V. M., Rivkees, S. A., et al. (2011) · Endocrine Practice · doi:10.4158/ep.17.3.456 · Cited by 1,098
“Subsequently, two cohort studies in which patients received levothyroxine therapy early after radioactive iodine with the specific intent of preventing hypothyroidism noted that deterioration of GO rarely occurred (0%-2%) (321,323).”
BackgroundBartalena, L., Baldeschi, L., Boboridis, K., Eckstein, A., Kahaly, G. J., Marcocci, C., Perros, P., Salvi, M., & Wiersinga, W. M. (2016) · European Thyroid Journal · doi:10.1159/000443828 · Cited by 943
2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism
Kahaly, G. J., Bartalena, L., Hegedüs, L., Leenhardt, L., Poppe, K. G., & Pearce, S. H. S. (2018) · European Thyroid Journal · doi:10.1159/000490384 · Cited by 1,025
The American Thyroid Association and American Association of Clinical Endocrinologists Taskforce on Hyperthyroidism and Other Causes of Thyrotoxicosis, Bahn, R. S., Burch, H. B., Cooper, D. S., Garber, J. R., Greenlee, M. C., Klein, I., Laurberg, P., McDougall, I. R., Montori, V. M., et al. (2011) · Thyroid · doi:10.1089/thy.2010.0417 · Cited by 898
“8 IU/Liter) (320), and hypothyroidism following radioiodine treatment (321).”
Background
Metadata
- Authors
- Tallstedt, L., Lundell, G., Blomgren, H., & Bring, J.
- Affiliations
- Karolinska University Hospital (SE)
- Uppsala University (SE)
- Corresponding author
- Tallstedt, Leif
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 1994-05
- Volume
- 130
- Issue
- 5
- Pages
- 494-497
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2153640804
- Cited by
- 171
- References
- 0
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 2 · 2022: 5 · 2021: 3 · 2020: 5 · 2019: 8 · 2018: 4 · 2017: 1 · 2016: 11 · 2015: 7 · 2014: 6 · 2013: 8 · 2012: 13
- FWCI
- 2.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Ophthalmology › 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' ophthalmopathy, thyroxine, radioiodine therapy, iodine-131, Graves' disease, hyperthyroidism, thyroid hormones, proptosis, prophylaxis, hypothyroidism
- MeSH terms
- Drug Administration Schedule, Exophthalmos, Female, Graves Disease, Humans, Hyperthyroidism, Iodine Radioisotopes, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Thyroxine, Time Factors, Confidence Intervals
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