Download PDF
Exp Clin Endocrinol Diabetes 2006; 114(7): 366-370
DOI: 10.1055/s-2006-924321
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Radioiodine Therapy of Graves' Hyperthyroidism in Patients Without Pre-existing Ophthalmopathy: Can Glucocorticoids Prevent the Development of New Ophthalmopathy?[1]

B. Dederichs1 , M. Dietlein1 , B. Jenniches-Kloth1 , M. Schmidt1 , P. Theissen1 , D. Moka1 , H. Schicha1
  • 1Department of Nuclear Medicine, University of Cologne, Germany
Further Information

Publication History

Received: December 8, 2004 First decision: April 10, 2005

Accepted: April 24, 2006

Publication Date:
16 August 2006 (online)

Also available at
    Permissions and Reprints

Abstract

Background: Radioiodine therapy (RIT) combined with glucocorticoids is an effective therapy for Graves' disease, but it is debatable whether glucocorticoids should be applied in patients without Graves' ophthalmopathy (GO). Methods: The effect of 0.4 - 0.5 mg prednisone every second day over a period of 5 weeks after RIT was monitored over a follow-up period of at least 12 months after RIT. A questionnaire was sent to 186 consecutive patients without GO concerning eye symptoms after RIT. 148 patients (80 %) answered. If eye symptoms had occurred after RIT, additional clinical examination was carried out at our outpatient clinic. The primary endpoint was the absence or onset of GO within the first year after RIT. Results: Within 12 months after RIT the examination confirmed GO in 5 out of 148 patients (3.4 %). In all cases the symptoms were transient. No adverse reaction to the use of prednisone after RIT was noted. Conclusions: The risk of new GO in the first year after RIT was low and the clinical course of GO was mild when RIT was combined with a low-dose glucocorticoid regimen. Preventive administration of glucocorticoids can therefore be recommended in patients with Graves' disease even without evident GO.

Key words

Radioiodine therapy - Graves' disease - ophthalmopathy - glucocorticoids - hyperthyroidism

1 Partly supported by Amersham & Buchler

References

  • 1 Bartalena L, Bogazzi F, Tanda M L, Manetti L, Dell'Unto E, Martino E. Cigarette smoking and the thyroid.  Eur J Endocrinol. 1995;  133 507-512
    CrossrefPubMedSearch in Google Scholar
  • 2 Bartalena L, Marcocci C, Pinchera A. On the effects of radioiodine therapy on Graves' ophthalmopthy.  Thyroid. 1998;  8 533-534
    CrossrefPubMedSearch in Google Scholar
  • 3 Bartalena L, Marcocci C, Bogazzi F, Manetti L, Tanda M L, Dell'Unto E, Bruno-Bossio G, Nardi M, Bartolomei M P, Lepri A, Rossi G, Martino E, Pinchera A. Relation between therapy for hyperthyroidism and the course of Graves' ophthalmopathy.  N Engl J Med. 1998 b;  338 73-78
    Search in Google Scholar
  • 4 Bartalena L, Marcocci C, Pinchera A. Graves' ophthalmopathy: a preventable disease?.  Eur J Endocrinol. 2002;  146 457-461
    CrossrefPubMedSearch in Google Scholar
  • 5 Burch H B, Wartofsky L. Graves' ophthalmopathy: current concepts regarding pathogenesis and management.  Endocr Rev. 1993;  14 747-793
    CrossrefPubMedSearch in Google Scholar
  • 6 Dederichs B, Otte R, Klink J E, Schicha H. Volume reduction of the thyroid after radioiodine therapy in patients with autonomous goiter and Basedow's goiter [in German].  Nuklearmedizin. 1996;  35 164-169
    PubMedSearch in Google Scholar
  • 7 Dietlein M, Dederichs B, Weigand A, Schicha H. Radioiodine therapy and thyroid-associated orbitopathy: risk factors and preventive effects of glucocorticoids.  Exp Clin Endocrinol Diabetes. 1999;  107 S190-194
    PubMedSearch in Google Scholar
  • 8 Dietlein M, Dressler I, Joseph K, Leisner B, Moser E, Reiners C, Schicha H, Schneider P, Schober O. Guidelines for radioiodine therapy (RIT) in benign thyroid diseases.  Nuklearmedizin. 1999 b;  38 (6 A) 219-220
    PubMedSearch in Google Scholar
  • 9 Dietlein M, Dressler J, Eschner W, Lassmann M, Leisner B, Reiners C, Schicha H. Procedure guideline for radioiodine test (version 2).  Nuklearmedizin. 2003;  42 116-119
    PubMedSearch in Google Scholar
  • 10 Dietlein M, Dressler J, Grunwald F, Joseph K, Leisner B, Moser E, Reiners C, Rendl J, Schicha H, Schneider P, Schober O. Guideline for in vivo- and in vitro procedures for thyroid diseases (version 2).  Nuklearmedizin. 2003 b;  42 109-115
    PubMedSearch in Google Scholar
  • 11 Heufelder A E. Pathogenesis of ophthalmopathy in autoimmune thyroid disease.  Rev Endocr Metab Disord. 2000;  1 87-95
    CrossrefPubMedSearch in Google Scholar
  • 12 Kung A W, Yau C C, Cheng A. The incidence of ophthalmopathy after radioiodine therapy for Graves' disease: prognostic factors and the role of methimazole.  J Clin Endocrinol Metab. 1994;  79 542-546
    CrossrefPubMedSearch in Google Scholar
  • 13 Marcocci C, Bartalena L, Bogazzi F, Bruno-Bossio G, Pinchera A. Relationship between Graves' ophthalmopathy and type of treatment of Graves' hyperthyroidism.  Thyroid. 1992;  2 171-178
    PubMedSearch in Google Scholar
  • 14 Miehle K, Paschke R. Therapy of hyperthyroidism.  Exp Clin Endocrinol Diabetes. 2003;  111 305-318
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Pinchera A, Bartalena L, Marcocci C. Therapeutic controversies.  Radioiodine may be bad for Graves' ophthalmopathy, but… J Clin Endocrinol Metab. 1995;  80 342-345
    PubMedSearch in Google Scholar
  • 16 Prummel M F, Wiersinga W M. Smoking a risk factor for hypothyroidism [correction of hyperthyroidism].  J Endocrinol Invest. 1993;  16 827
    PubMedSearch in Google Scholar
  • 17 Sahlmann C O, Siefker U, Lehmann K, Harms E, Conrad M, Meller J. Quantitative thyroid scintigraphy for the differentiation of Graves' disease and hyperthyroid autoimmune thyroiditis.  Nuklearmedizin. 2004;  43 124-128
    PubMedSearch in Google Scholar
  • 18 Saleh A, Cohnen M, Furst G, Godehardt E, Modder U, Feldkamp J. Differential diagnosis of hyperthyroidism: Doppler sonographic quantification of thyroid blood flow distinguishes between Graves' disease and diffuse toxic goiter.  Exp Clin Endocrinol Diabetes. 2002;  110 32-36
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Sridama V, DeGroot L J. Treatment of Graves' disease and the course of ophthalmopathy.  Am J Med. 1989;  87 70-73
    PubMedSearch in Google Scholar
  • 20 Tallstedt L, Lundell G, Blomgren H, Bring J. Does early administration of thyroxine reduce the development of Graves' ophthalmopathy after radioiodine treatment?.  Eur J Endocrinol. 1994;  130 494-497
    CrossrefPubMedSearch in Google Scholar
  • 21 Tallstedt L, Lundell G. Radioiodine treatment, ablation, and ophthalmopathy: a balanced perspective.  Thyroid. 1997;  7 241-245
    PubMedSearch in Google Scholar
  • 22 Tellez M, Cooper J, Edmonds C. Graves' ophthalmopathy in relation to cigarette smoking and ethnic origin.  Clin Endocrinol (Oxf). 1992;  36 291-294
    PubMedSearch in Google Scholar
  • 23 Wallaschofski H, Kuwert T, Lohmann T. TSH-receptor autoantibodies - differentiation of hyperthyroidism between Graves' disease and toxic multinodular goitre.  Exp Clin Endocrinol Diabetes. 2004;  112 171-174
    Thieme ConnectPubMedSearch in Google Scholar
  • 24 Wartofsky L. Classification of eye changes of Graves' disease.  Thyroid. 1992;  2 235-236
    PubMedSearch in Google Scholar
  • 25 Weigand A, Hinzpeter B, Schicha H. Worsening of endocrine ophthalmopathy after radioiodine therapy in Graves' disease?.  [in German] Nuklearmedizin. 1998;  37 234-238
    PubMedSearch in Google Scholar
  • 26 Wiersinga W M. Preventing Graves' ophthalmopathy.  N Engl J Med. 1998;  338 121-122
    CrossrefPubMedSearch in Google Scholar
  • 27 Wiersinga W M. Environmental factors in autoimmune thyroid disease.  Exp Clin Endocrinol Diabetes. 1999;  107 S67-70
    PubMedSearch in Google Scholar
  • 28 Winsa B, Mandahl A, Karlsson F A. Graves' disease, endocrine ophthalmopathy and smoking.  Acta Endocrinol (Copenh). 1993;  128 156-160
    PubMedSearch in Google Scholar

1 Partly supported by Amersham & Buchler

Dr. Birgit Dederichs

Department of Nuclear Medicine
University of Cologne

50924 Cologne

Germany

Phone: + 492214784050

Fax: + 49 22 14 78 67 77

Email: Harald.Schicha@uni-koeln.de