Abstract
Introduction: Radioactive iodine may increase the risk of ophthalmopathy (GO) in Graves disease (GD) patients, thus, is sometimes not considered. The aim of the study was the prospective assessment of the risk of GO development or exacerbation in GD patients treated with 131I if glucorticoid (GCS) therapy was introduced in at risk patients based on CAS and NOSPECS scores.
Material: 208 consecutive patients treated with 131I were enrolled, despite of GO presence or severity. According to Bartalena et al., GCS were administered to all patients with GO or smoking patients. In cases with severe GO, intravenous GCS therapy preceded radioiodine. 98 patients, in whom one year observation has already been finished, are evaluated.
Methods: Patients were monitored at 1, 3, 6-8 and 12 months after radioiodine therapy. MRI examination was performed before and 1 year after the 131I treatment. Thyrotropin receptor antibodies (TRAbs) were measured at baseline, then a month and a year post 131I therapy.
Results: (48%) 47 patients received GCS. 37 of them (38%) showed GO symptoms at the administration of 131I. GO deterioration (CAS 4-6) was observed in 8 patients (8.2% of the whole group and 18.9% of the GO group) and 2 of them required full GCS treatment. One patient, (1% of the whole group and 2% of the group without GO) developed GO after 131I treatment. No significant side effects of GCS therapy were observed.
Conclusions: Our prospective observation confirms that wide use of radioiodine in GD is associated with a low risk of severe oftalmopathy when concomitted by appropriate administration of therapeutic or prophylactic glucocorticoid treatment.