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Thyroid. 1992 Summer;2(2):171-8. Related Articles, Links

Relationship between Graves' ophthalmopathy and type of treatment of

Graves' hyperthyroidism.

Marcocci C, Bartalena L, Bogazzi F, Bruno-Bossio G, Pinchera A.

Istituto di Endocrinologia, Universita di Pisa, Italy.

The relationship between the treatment of Graves' hyperthyroidism

and the course of ophthalmopathy is rather unclear. Antithyroid

drugs may improve eye manifestations, possibly by restoring normal

thyroid function and reducing orbit-directed autoimmune reactions,

whereas ophthalmopathy may worsen after radioiodine administration

or thyroidectomy. This might occur because of a treatment-related

release of thyroid antigens and activation of the autoimmune

response that might involve the orbit. On the other hand, some

authors suggest that complete thyroid ablation, either by

radioiodine or surgery, might be beneficial for ophthalmopathy.

However, reported effects of radioiodine and thyroidectomy on

Graves' ophthalmopathy are conflicting. This may be due, at least in

part, to the retrospective feature of most studies and the lack of

precise evaluation of ocular involvement. Two prospective studies

were performed in which patients with Graves' disease with mild or

no ophthalmopathy were randomly assigned to treatment by radioiodine

or subtotal thyroidectomy alone or in association with systemic

glucocorticoids. Both treatments were followed by a progression of

pre-existing mild ophthalmopathy in a substantial proportion of

cases: glucocorticoids prevented such an exacerbation.

Ophthalmopathy did not develop in patients without clinical evidence

of eye disease prior to therapy. Therefore, it is recommended that a

course of glucocorticoids be instituted concomitantly with

radioiodine therapy or thyroidectomy in Graves' patients with some

degree of ocular involvement.

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