Radioiodine and thyroid-associated ophthalmopathy

Particular attention has recently been paid to the relationship between radioiodine administration and the course of thyroid-associated ophthalmopathy (TAO). Conflicting results have been reported in the literature, and radioiodine therapy has been associated either with aggravation, improvement, or no relevant changes of eye disease. Retrospective observations and recent prospective studies suggest that radioiodine can worsen preexisting ophthalmopathy and that these untoward ocular effects can be prevented by concomitant glucocorticoid administration. In the authors' experience, subtotal thyroidectomy can sometimes be associated with an exacerbation of ophthalmopathy; antithyroid drugs per se do not cause relevant changes in eye disease, but drug withdrawal is frequently followed by a relapse of hyperthyroidism which adversely affects the course of ophthalmopathy. Based on these considerations, the authors suggest that in Graves' disease patients with significant eye manifestations, a rapid and permanent control of thyroid hyperfunction should be obtained. Considered that the possible exacerbation of ophthalmopathy can be prevented by short-term glucocorticoid treatment, the authors believe that radioiodine can be effectively and conveniently used to achieve this goal. Indeed, radioiodine therapy provides permanent control of hyperthyroidism, thus avoiding exacerbations from recurrences, and thyroid ablation in the long run may beneficially affect the course of eye disease.