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Volume 338:73-78 January 8, 1998 Number 2 Next

	Full Text PDF Editorial by Wiersinga, W. M. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article by Gorman, C. A. PubMed Citation

ABSTRACT

Background The chief clinical characteristics of Graves' disease are hyperthyroidism and ophthalmopathy. The relation between the two and the effect of treatment for hyperthyroidism on ophthalmopathy are unclear.

Methods We studied 443 patients with Graves` hyperthyroidism and slight or no ophthalmopathy who were randomly assigned to receive radioiodine, radioiodine followed by a 3-month course of prednisone, or methimazole for 18 months. The patients were evaluated for changes in the function and appearance of the thyroid and progression of ophthalmopathy at intervals of 1 to 2 months for 12 months. Hypothyroidism and persistent hyperthyroidism were promptly corrected.

Results Among the 150 patients treated with radioiodine, ophthalmopathy developed or worsened in 23 (15 percent) two to six months after treatment. The change was transient in 15 patients, but it persisted in 8 (5 percent), who subsequently required treatment for their eye disease. None of the 55 other patients in this group who had ophthalmopathy at base line had improvement in their eye disease. Among the 145 patients treated with radioiodine and prednisone, 50 (67 percent) of the 75 with ophthalmopathy at base line had improvement, and no patient had progression. The effects of radioiodine on thyroid function were similar in these two groups. Among the 148 patients treated with methimazole, 3 (2 percent) who had ophthalmopathy at base line improved, 4 (3 percent) had worsening of eye disease, and the remaining 141 had no change.

Conclusions Radioiodine therapy for Graves' hyperthyroidism is followed by the appearance or worsening of ophthalmopathy more often than is therapy with methimazole. Worsening of ophthalmopathy after radioiodine therapy is often transient and can be prevented by the administration of prednisone.

Source Information

From the Istituto di Endocrinologia (L.B., C.M., F.B., L.M., M.L.T., E.D., G.B.-B., E.M., A.P.) and the Clinica Oculistica (M.N., M.P.B., A.L.), University of Pisa, and the Reparto di Epidemiologia e Biostatistica, Istituto di Fisiologia Clinica, National Research Council (G.R.) — all in Pisa, Italy.

Address reprint requests to Dr. Bartalena at the Istituto di Endocrinologia, University of Pisa, Ospedale Cisanello, Via Paradisa, 3, 56122 Pisa, Italy.

Full Text of this Article

Related Letters:

Therapy for Hyperthyroidism and Graves' Ophthalmopathy
Gorman C. A., Offord K. P., Bartalena L., Marcocci C., Pinchera A.
Extract | Full Text  
N Engl J Med 1998; 338:1546-1547, May 21, 1998. Correspondence

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• Woeber, K. A. (1999). The Year in Review: The Thyroid. ANN INTERN MED 131: 959-962 [Abstract] [Full Text]  
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• Colao, A., Lastoria, S., Ferone, D., Pivonello, R., Macchia, P. E., Vassallo, P., BonavolontÁ, G., Muto, P., Lombardi, G., Fenzi, G. (1998). Orbital Scintigraphy with [111In-Diethylenetriamine Pentaacetic Acid-D-Phe1]-Octreotide Predicts the Clinical Response to Corticosteroid Therapy in Patients with Graves' Ophthalmopathy. J. Clin. Endocrinol. Metab. 83: 3790-3794 [Abstract] [Full Text]  
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• (1998). THE COURSE OF OPHTHALMOPATHY IN TREATED GRAVES' DISEASE. JWatch General 1998: 7-7 [Full Text]  
• Wiersinga, W. M. (1998). Preventing Graves' Ophthalmopathy. NEJM 338: 121-122 [Full Text]