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Submitted on March 8, 2005
Accepted on June 17, 2005
Petros Perros Endocrine Unit, Freeman Hospital, Newcastle upon Tyne, UK, Pat Kendall-Taylor School of Clinical Medical Sciences, University of Newcastle upon Tyne, UK; Chris Neoh Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK; Sarah Frewin Endocrine Unit, Freeman Hospital, Newcastle upon Tyne, UK; Jane Dickinson Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
* To whom correspondence should be addressed. E-mail: Petros.Perros{at}ncl.ac.uk.
Context: Radioiodine is an effective and safe treatment for hyperthyroidism but has been implicated as a risk factor for deterioration or new presentation of Graves' ophthalmopathy (GO). Prophylactic glucocorticoids appear to prevent this effect.
Objective: To document the course of GO following radioiodine therapy.
Design: Prospective observational study. Patients were assessed at baseline 2, 4, 6 and 12 months post-radioiodine.
Setting: Tertiary referral center.
Patients: 72 GO patients with minimally active eye disease.
Intervention: A fixed dose of radioiodine was administered. Thyroxine was commenced 2 weeks later to prevent hypothyroidism.
Main outcome measures: Change in activity and severity of GO.
Results: Exophthalmometer readings, the width of the palpebral aperture, diplopia scores and the clinical activity score (CAS) improved significantly. By clinically significant criteria, the eye disease improved in 4 patients (transiently in 3 of the 4 cases), most likely attributable to the natural course of the disease. No patient's eyes deteriorated.
Conclusions: Radioiodine is not associated with deterioration of GO in patients with minimally active eye disease when post-radioiodine hypothyroidism is prevented.
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