Relation between therapy for hyperthyroidism and the course of Graves' ophthalmopathy
摘要
The treatment of hyperthyroidism fromGraves' disease may affect the course of the associated ophthalmopathy. The authors studied 443 patients with Graves' hyperthyroidism with slight or no ophthalmopathy who were randomly assigned to receive radioiodine, radioiodine followed by a 3-month course of prednisone, or methimazole for 18 months. Among the 150 patients treated with radioiodine, ophthalmopathy developed or worsened in 23 (15%) 2 to 6 months after treatment. The change was transient in 15 patients, but it persisted in eight (5%), who subsequently required treatment for their eye disease. None of the 55 other patients in this group who had ophthalmopathy at baseline had improvement in their eye disease. Among the 145 patients treated with radioiodine and prednisone, 50 (67%) of the 75 with ophthalmopathy at baseline had improvement, and no patient had progression. The effects of radioiodine on thyroid function were similar in these two groups. Among the 148 patients treated with methimazole, three (2%) who had ophthalmopathy at baseline improved, four (3%) had worsening of eye disease, and the remaining 141 had no change. The authors conclude that radioiodine therapy for Graves' hyperthyroidism is followed by the appearance or worsening of ophthalmopathy more often than is therapy with methimazole. Worsening of ophthalmopathy after radioiodine therapy is often transient and can be prevented by the administration of prednisone.