Re: comments in NEJM about Dr. Bartalena's study

[Guest guest]

A very quick note for newbies: the gist of this is, what is the

correlation between RAI and thyroid eye disease? I don't usually follow

all this but this was in simple enough English for me. To find out more

about TED you can read Elaine's new book. I haven't yet, and assume that

there will be a lot of technical jargon and studies there, but also alot

of info in plain English to clarify this. Don't let any endo dismiss TED

as a trivial concern!

The question must be considered in

> the context of the natural history of Graves' ophthalmopathy. In

> patients with Graves' hyperthyroidism, eye disease appears before

> the onset of hyperthyroidism in about 20 percent, at the same time

> as hyperthyroidism in about 40 percent, and after hyperthyroidism in

> about 40 percent

I assume they mean of the patients who have TED, not in all patients with

GD, which is what this sentence implies. Not brilliant editing.

Furthermore, this eye disease often improves

> spontaneously. In a recent study of 59 patients with ophthalmopathy

> who were followed for one year, the condition improved substantially

> in 22 percent and slightly in 42 percent; 22 percent had no change,

> and 14 percent had worsening.1

What is the " 1 " here referring to? Couldn't find it. What do they call

spontaneous? That year could have included a course of ATDs, which bring

down the antibodies believed to be involved in TED.

> Ophthalmopathy developed or worsened in 15 percent of the patients

> treated with radioiodine, in none of those treated with radioiodine

> and prednisone, and in 3 percent of those treated with methimazole.

> The good results obtained with radioiodine plus prednisone indicate

> only that prednisone is effective in patients with Graves'

> ophthalmopathy.

How long-term a study was this? I'm not as familiar with this study as

other members of the group.

To evaluate which treatment for Graves'

> hyperthyroidism entails the lowest risk of the development or

> progression of eye disease, the proper comparison is between the

> radioiodine and methimazole groups...

From my very limited understanding of the subject the conclusions seem

correct. Interesting that they only used methimazole, and only followed

this for a year, when a complete course of ATD should usually be given 12

-24 months, minimum.

Take care, Fay

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