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Patients With Graves' Disease Treated With Radioiodine I-131 at Risk of Graves' Ophthalmology: Presented at ECE

By Chris Berrie

BERLIN -- May 6, 2008 -- Radioiodine therapy for patients with Graves' disease can promote development of severe Graves' ophthalmopathy (GO), thus indicating the need for preventive administration of glucocorticoids in patients with Graves' disease who even display mild ophthalmology, according to a retrospective analysis.

Principal investigator Agata Baldys-Waligórska, MD, Associate Professor, Chair and Clinic of Endocrinology, Collegium Medicum, Jagiellonian University, Krakow, Poland, presented the findings here at the 10th European Congress of Endocrinology (ECE).

Graves' ophthalmopathy is associated with autoimmune thyroid disease. Its course is influenced by treatment for thyrotoxicosis, and radioiodine therapy has been recognised as being an important risk factor, Dr. Baldys-Waligórska explained.

Her team of researchers studied the activity and severity of ophthalmopathy in patients who acquired GO after receiving radioiodine therapy. Patients had a Clinical Activity Score (CAS) <3 and <3 grade classification of signs and symptoms (ie, no signs or symptoms; only signs and no symptoms; signs only; proptosis; eye muscle involvement; corneal involvement; sight visual acuity reduction; NOSPECS).

Of the overall group of hyperthyroid patients, 50.9% had Graves' disease, and 5% of these developed GO in the first year of follow-up (mean onset, 23.4 weeks). After receiving radioiodine treatment, the maximum thyroid-stimulating hormone median level was 6.2 mcU/mL, and 82% of patients were hypothyroid.

"All patients were rendered euthyroid at the time of GO treatment," Dr. Baldys-Waligórska noted in her presentation on May 4. This treatment consisted of methylprednisolone pulse therapy (8.0 g) and subsequent radiotherapy (20 Gy), as well as L-thyroxine or methimazole where appropriate.

Prior to steroid treatment, 55% of patients had CAS of 4 or greater, and 79% of patients had moderately severe to severe GO.

Over 1 year of GO therapy, statistical significance was seen for decreases in median CAS values (P < .05), median hTRAb levels (P < .05), and median Total Eye Score (TES) values (P < .05). Dr. Baldys-Waligórska also noted that 12 months after GO treatment, 55% of patients remained positive on the human thyroid-stimulating hormone-receptor antibodies assay (hTRAb), while most of the patients showed an improved TES.

Similarly, 1 year after GO therapy, the mild cases of GO had significantly lower median hTRAb levels (P < .05, for CAS and TES). For these mild cases, Dr. Baldys-Waligórska noted, "This may mean that 12 months after GO therapy, the autoimmune process subsided."

For interleukin (IL)-2 and IL-6, large ranges were seen, with median levels in the normal upper range, and these did not change significantly 1 month after GO therapy.

Finally, across the NOSPECS classes, prior to GO treatment (n = 39), there were high percentages of grade 3 (classes 1-6: 24%, 21%, 3%, 30%, 15%, 0%), although with GO treatment over 6 months only 1 patient was seen to worsen (classes 1-6: 8%, 0%, 0%, 8%, 8%, 3%).

"Five percent of Graves' disease patients develop GO following radioiodine treatment, and thus the association between radioiodine therapy and ophthalmopathy cannot be excluded," Dr. Baldys-Waligórska concluded.

As a significant number of these patients develop moderately severe GO, the researchers recommended preventive administration of glucocorticoids in patients with Graves' disease, and even with mild ophthalmopathy.

[Presentation title: Graves' Ophthalmology in Patients Treated With Radioiodine I-131. Abstract OC2.8]

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