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Ablative Versus Conservative Approach for Hyperthyroidism Treatment in Patients with Graves' Orbitopathy: A
Giada Cosentino1, Giulia Lanzolla1, Simone Comi1
1Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy.
Thyroid : Official Journal of the American Thyroid Association
|February 5, 2025
Summary
Radioactive iodine (RAI) treatment for Graves' hyperthyroidism may lead to an earlier response in Graves' orbitopathy patients receiving glucocorticoids. Long-term outcomes were similar, but RAI was linked to more infections.
Area of Science:
- Endocrinology
- Ophthalmology
- Thyroid Disease Management
Background:
- Graves' hyperthyroidism (GH) treatment in patients with Graves' orbitopathy (GO) is debated.
- GO requires careful management alongside thyroid treatment.
Purpose of the Study:
- To investigate the outcome of GO following glucocorticoid treatment, comparing radioactive iodine (RAI) and methimazole (MMI) for GH.
Main Methods:
- Retrospective cohort study of 49 GH patients with moderate-to-severe active GO.
- Patients received intravenous methylprednisolone, with GH treated by RAI (24 patients) or MMI (25 patients).
- GO outcomes assessed at 24, 48, and 72 weeks based on predefined criteria.
Main Results:
- RAI showed a significantly greater proportion of responders at week 24 (54.1% vs. 16%).
- Long-term GO outcomes and quality of life improvements were similar between RAI and MMI groups by week 48/72.
- Infections were more frequent in the RAI group (53.8% vs. 15.3%).
Conclusions:
- RAI may be associated with an earlier GO response to intravenous glucocorticoids compared to MMI.
- Long-term effectiveness appears comparable, suggesting a conservative approach is also viable.
- RAI seems relatively safe with concurrent glucocorticoid therapy, though infection risk warrants consideration.
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