Re: shiela again, review from same author as your link

[Guest guest]

Here is a review from the same author as the paper you provided. it

might give you some additional information about it.

Best Wishes,

Liang

Thyroid. 1997 Apr;7(2):259-64. Related Articles, Links

Radioiodine and the immune system.

DeGroot LJ.

Department of Medicine, University of Chicago, Illinois 60637-1470,

USA.

Treatment of Graves' disease patients with radioactive iodide (RAI)

can induce two therapeutically important alterations in immune

response to thyroid antigens. These may be characterized as a first

response and a second phase response. Initial treatment of patients

with Graves' disease by RAI leads to killing of thyroid cells and

releases antigen into the circulation. In association with this,

there is a dramatic increase in levels of thyroid-stimulating

immunoglobulins and in cell-mediated immunoreactivity to TSH receptor

(TSH-R) and it peptide epitopes. During this phase, ophthalmopathy

often is exacerbated. Although it is logical to believe that the

release of antigens and stimulation of immunoreactivity is the cause

of the worsened ophthalmopathy, a direct cause and effect only can be

inferred. Ophthalmopathy often remains a significant problem or

develops during the course of treatment of Graves' disease. My

observations are that almost all patients who have progressive

ophthalmopathy after many form of thyroid treatment usually have

residual thyroid tissue stimulated by thyroid stimulating antibodies,

even though they may be hypothyroid and on replacement therapy. In

this situation, destruction of residual thyroid tissue is associated

with amelioration in ophthalmopathy and is presumed to be effective

because of diminution in antigenic stimulation, with a subsequent

drop in antibody levels and cell-mediated immunoreactivity to TSH-R

extracellular domain (ECD). This constitutes a second phase in the

radioiodine response, with effects dramatically different from the

initial phase, because this phase is associated with a loss in

antigenic stimulation rather than an increase. In a series now

comprising > 40 patients treated in an uncontrolled prospective

manner, comparison to preablation and postablation ophthalmopathy

demonstrates clear benefit in almost all patients over a period of 3-

12 months. Radioiodine ablation of residual thyroid tissue is the

logical first treatment in management of severe ophthalmopathy and

should be used before or with the institution of steroids or

radiotherapy.

Publication Types:

Review

Review, Tutorial

[Guest guest]

Thanks, Liang. I had read this and I think that it still supports my

concerns.

There may be a real benefit in the long term for patients with TED, BUT,

unless people like Reynolds are adequately informed of the potential

negative short-term effects and knowingly take the risk as informed partners

in their treatment plan, and more studies are done to effect better

prediction of, and mitigation of, negative responses to RAI, patients are

not being treated well.

Appreciating you,

Sheila

Re: shiela again, review from same author as your

link

Here is a review from the same author as the paper you provided. it

might give you some additional information about it.

Best Wishes,

Liang

Thyroid. 1997 Apr;7(2):259-64. Related Articles, Links

Radioiodine and the immune system.

DeGroot LJ.

Department of Medicine, University of Chicago, Illinois 60637-1470,

USA.

Treatment of Graves' disease patients with radioactive iodide (RAI)

can induce two therapeutically important alterations in immune

response to thyroid antigens. These may be characterized as a first

response and a second phase response. Initial treatment of patients

with Graves' disease by RAI leads to killing of thyroid cells and

releases antigen into the circulation. In association with this,

there is a dramatic increase in levels of thyroid-stimulating

immunoglobulins and in cell-mediated immunoreactivity to TSH receptor

(TSH-R) and it peptide epitopes. During this phase, ophthalmopathy

often is exacerbated. Although it is logical to believe that the

release of antigens and stimulation of immunoreactivity is the cause

of the worsened ophthalmopathy, a direct cause and effect only can be

inferred. Ophthalmopathy often remains a significant problem or

develops during the course of treatment of Graves' disease. My

observations are that almost all patients who have progressive

ophthalmopathy after many form of thyroid treatment usually have

residual thyroid tissue stimulated by thyroid stimulating antibodies,

even though they may be hypothyroid and on replacement therapy. In

this situation, destruction of residual thyroid tissue is associated

with amelioration in ophthalmopathy and is presumed to be effective

because of diminution in antigenic stimulation, with a subsequent

drop in antibody levels and cell-mediated immunoreactivity to TSH-R

extracellular domain (ECD). This constitutes a second phase in the

radioiodine response, with effects dramatically different from the

initial phase, because this phase is associated with a loss in

antigenic stimulation rather than an increase. In a series now

comprising > 40 patients treated in an uncontrolled prospective

manner, comparison to preablation and postablation ophthalmopathy

demonstrates clear benefit in almost all patients over a period of 3-

12 months. Radioiodine ablation of residual thyroid tissue is the

logical first treatment in management of severe ophthalmopathy and

should be used before or with the institution of steroids or

radiotherapy.

Publication Types:

Review

Review, Tutorial