Graves' Disease Support Group

Marpo....
I found this article by Miriam E. Tucker and quite interesting.
Please feel free to use these articles in your meetings and speeches.


WASHINGTON -- Graves' ophthalmopathy is uncommon in the first year after ablative radioiodine therapy, Julie E. Hallanger-Johnson, M.D., and her associates reported in a poster at the annual meeting of the American Association of Clinical Endocrinologists.

Graves' ophthalmopathy affects up to 30% of patients with Graves' disease, with severe effects reported in 3%-5%.

The influence of radioiodine therapy on the development of Graves' ophthalmopathy is not clear and is considered a controversial area.

Randomized data of good quality are not available, and no reliable clinical or laboratory predictors of the development of Graves' ophthalmopathy following radioiodine therapy have been identified, although tobacco use has been suggested as a possible risk factor, said Dr. Hallanger-Johnson of the Mayo Clinic, Rochester, Minn., and her associates.

At the clinic, radioiodine therapy is the first choice of treatment for hyperthyroid adult Graves' patients, regardless of the presence or severity of ophthalmopathy.

For the study, the investigators reviewed the charts of 592 such patients who had received their first radioiodine therapy between 1990 and 1993.

Most of the patients were women (76.9%), and the group had a mean age of 49 years. The majority (63.2%) had a history of smoking, 45.7% were current smokers, and 19.9% had taken antithyroid medication before being referred to Mayo.

Graves' ophthalmopathy was present prior to radioiodine therapy in 17.7% (105) of the patients, comprising 21% of the smokers and 14% of the nonsmokers.

The patients with Graves' ophthalmopathy at baseline had significantly higher levels of thyroid-stimulating immunoglobulin. Those patients also were more likely to have been taking antithyroid medication (36.2% vs. 16.9%), suggesting that the referring physicians were under the impression that radioiodine therapy might have adverse effects on Graves' ophthalmopathy, the investigators noted.

The rate of new-onset Graves' ophthalmopathy was 5% in the first year after radioiodine therapy, rising to 19.6% at 10 years, the investigators reported.

Patient survival free of Graves' ophthalmopathy was 94.9% at 1 year, 86.3% at 3 years, 85.8% at 5 years, and 80.4% at 10 years.

The development of new-onset Graves' ophthalmopathy was not associated with gender, smoking status, serum thyroxine concentrations, thyroid weight, patient age, or the need for a second dose of radioactive iodine.

However, development of new-onset Graves' ophthalmopathy was marginally related to higher concentrations of thyroid-stimulating immunoglobulin, the investigators reported.

The purported adverse effects of radioiodine therapy and the increase in thyroid-stimulating hormone receptor antibodies typically occur in the first few months after radioiodine therapy.

The fact that new cases of Graves' ophthalmopathy occurred in just 5% of study patients in the first year, with the rate remaining steady for the first 3 years, makes it unlikely that radioiodine therapy has an adverse effect on patients who do not already have Graves' ophthalmopathy at baseline, Dr. Hallanger-Johnson and her associates pointed out.

The study did not address the course of eye disease among the 17% of patients who already had Graves' ophthalmopathy at baseline, the investigators noted.

BY MIRIAM E. TUCKER

Senior Writer

Thats a big percentage rate in my books.

Debs
Posted on 09/08/08, 06:09 pm