Original Article
Relation between Therapy for Hyperthyroidism and the Course of Graves' Ophthalmopathy
N Engl J Med 1998; 338:73-78January 8, 1998
- Abstract
Background
The chief clinical characteristics of Graves' disease are hyperthyroidism and ophthalmopathy. The relation between the two and the effect of treatment for hyperthyroidism on ophthalmopathy are unclear.
Methods
We studied 443 patients with Graves` hyperthyroidism and 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. The patients were evaluated for changes in the function and appearance of the thyroid and progression of ophthalmopathy at intervals of 1 to 2 months for 12 months. Hypothyroidism and persistent hyperthyroidism were promptly corrected.
Results
Among the 150 patients treated with radioiodine, ophthalmopathy developed or worsened in 23 (15 percent) two to six months after treatment. The change was transient in 15 patients, but it persisted in 8 (5 percent), who subsequently required treatment for their eye disease. None of the 55 other patients in this group who had ophthalmopathy at base line had improvement in their eye disease. Among the 145 patients treated with radioiodine and prednisone, 50 (67 percent) of the 75 with ophthalmopathy at base line 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, 3 (2 percent) who had ophthalmopathy at base line improved, 4 (3 percent) had worsening of eye disease, and the remaining 141 had no change.
Conclusions
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.
Media in This Article
Figure 1
Changes in the Degree of Ophthalmopathy in Patients with Hyperthyroidism Who Were Treated with Radioiodine, Radioiodine and Prednisone, or Methimazole.Figure 2
Kaplan–Meier Plots of the Development or Progression of Ophthalmopathy in Patients with Hyperthyroidism Who Were Treated with Radioiodine, Radioiodine and Prednisone, or Methimazole.Article Activity
- Article
The relation between the treatment of hyperthyroidism due to Graves' disease and the course of Graves' ophthalmopathy is a matter of controversy.1 Antithyroid-drug treatment appears not to be associated with the development or worsening of preexisting eye disease.2 The effect of thyroidectomy is less clear, but in general it probably does not induce or worsen eye disease.3-5 In contrast, the effects of radioiodine therapy are less clear; ocular improvement, worsening of eye disease, and no change have been reported in different studies.4 To address this question, we undertook a prospective, randomized study of the effects of the treatment of Graves' hyperthyroidism with methimazole or radioiodine therapy, as well as the effects of glucocorticoids, in patients with mild or moderate Graves' ophthalmopathy or none.
Methods
Subjects
We enrolled 450 patients with Graves' disease (characterized by hyperthyroidism, diffuse goiter, and thyroid autoantibodies in serum) and mild ophthalmopathy or none. Mild ophthalmopathy was defined as proptosis of less than 22 mm, intermittent diplopia or none, an absence of optic neuropathy, and mild conjunctival and periorbital inflammation. Seven patients were lost to follow-up soon after enrollment, leaving 443 in the study cohort. Patients with severe ophthalmopathy requiring treatment with orbital radiotherapy and glucocorticoids, those with large goiters requiring thyroidectomy, and those with contraindications to glucocorticoid treatment were excluded before enrollment. The study was approved by the institutional review board of the Institute of Endocrinology, and all patients gave their informed, written consent.
Treatment
All the patients were treated with methimazole for three to four months. They were then randomly assigned to receive radioiodine therapy, radioiodine therapy plus prednisone, or continued methimazole therapy. Methimazole was discontinued five days before the administration of radioiodine (given at a dose of 120 to 150 μCi [4.4 to 5.6 MBq] per gram of thyroid tissue). The patients in the radioiodine–prednisone group were initially given 0.4 to 0.5 mg of prednisone per kilogram of body weight starting two to three days after radioiodine therapy and continuing for one month; the dose was then tapered over a period of two months, and the drug was discontinued.6 Of the initial 450 patients, 315 (70 percent) had been given a diagnosis of hyperthyroidism and had previously been treated with methimazole, and 135 were euthyroid when referred to our center. The patients were seen and their thyroid function was checked within 1 month after radioiodine therapy and then every 1 to 2 months for 12 months. Hypothyroidism or persistent (i.e., uncontrolled) hyperthyroidism after radioiodine treatment was corrected within two to three weeks by the administration of thyroxine or methimazole, respectively. A second dose of radioiodine was administered to patients who had persistent hyperthyroidism at the end of follow-up. The methimazole-treated patients received the lowest dose of the drug that maintained euthyroidism.
Ocular Examinations
Ocular examinations were carried out every one to two months by a single examiner, who did not know which treatment was being administered to the patient. The examinations included evaluation of soft-tissue changes; measurements of proptosis (by Hertel exophthalmometer), lid width, and lagophthalmos; evaluation of eye-muscle function with the Hess chart; and determination of visual acuity. The activity of ophthalmopathy was scored by the method of Mourits et al.,7 which takes into consideration seven manifestations of disease (spontaneous retrobulbar pain, pain with eye movement, eyelid erythema, eyelid edema, conjunctival injection, chemosis, and swelling of the caruncle); one point is given for any manifestation, and the score may range from 0 (no activity) to 7 (very high activity). At each visit, the patients were asked to describe their eye disease as improved, unchanged, or worsened as compared with their last visit.
We defined the appearance, progression, or improvement of ophthalmopathy according to major and minor criteria. The major criteria were variations of 2 mm or more in exophthalmometric readings and lid width, the appearance or disappearance of diplopia (intermittent [i.e., present only occasionally], inconstant [i.e., present but not in primary gaze], constant [present in primary gaze]), variations of two points or more in the ophthalmopathy-activity score, and changes of 1/10 or more in visual acuity. Minor criteria were variations in soft tissues or in the patient's assessment of his or her disease. The appearance, progression, or improvement of ophthalmopathy was defined as the appropriate change in at least two major and one minor criteria. The need for subsequent orbital radiotherapy and high-dose prednisone therapy for severe ophthalmopathy was determined by an overall evaluation that took into account the degree of inflammatory changes and related symptoms, the extent of proptosis and extraocular muscle dysfunction, any optic-nerve involvement, and the degree of interference with the patient's daily activities.
Evaluation of Thyroid Function
Thyroid function was assessed by measuring serum free thyroxine and free triiodothyronine (Lisophase kits, Laboratori Bouty, Sesto San Giovanni, Italy) and serum thyrotropin (Auto-Delfia Wallac, Gaithersburg, Md.). The normal ranges were as follows: free thyroxine, 0.6 to 1.8 ng per deciliter (8.4 to 23.2 pmol per liter); free triiodothyronine, 0.25 to 0.6 ng per deciliter (3.8 to 8.4 pmol per liter); and thyrotropin, 0.4 to 3.7 mU per liter. Serum thyrotropin-receptor antibody was measured by radioreceptor assay (Trak assay, Brahms Diagnostica, Berlin, Germany; normal value, <5 U per liter).
Statistical Analysis
Base-line values in the three groups were compared by one-way analysis of variance and the Kruskal–Wallis test for quantitative variables and the two-tailed Fisher's exact test for qualitative variables. Differences between pretreatment and post-treatment values for exophthalmometric readings, lid-width measurements, and ophthalmopathy-activity scores were compared by the two-tailed Student's t-test and the Wilcoxon test; differences in diplopia status (absent vs. present) in the groups were evaluated with the exact binomial test for paired data. Differences among or within treatment groups with respect to the progression of ophthalmopathy and thyroid status were evaluated with the two-tailed Fisher's exact test. Exact binomial 95 percent confidence intervals were calculated for the proportion of patients who had development, worsening, or improvement of ophthalmopathy. Kaplan–Meier survival curves were used to illustrate the pattern of occurrence of ophthalmopathy according to treatment group.
Results
There were no significant differences in the base-line clinical and biochemical characteristics of the patients in the three treatment groups (Table 1Table 1
Base-Line Characteristics of the Three Groups of Patients with Graves' Hyperthyroidism.). The proportions of patients with and without ophthalmopathy at base line were similar.Among the 150 patients treated with radioiodine alone, ophthalmopathy developed or worsened in 23 (15 percent; 95 percent confidence interval, 10 to 22 percent) during the year after treatment (Figure 1Figure 1
Changes in the Degree of Ophthalmopathy in Patients with Hyperthyroidism Who Were Treated with Radioiodine, Radioiodine and Prednisone, or Methimazole.): 17 of the 72 patients with preexisting ophthalmopathy (24 percent; 95 percent confidence interval, 14 to 35 percent) and 6 of the 78 patients without ophthalmopathy (8 percent; 95 percent confidence interval, 3 to 16 percent; P = 0.01). In all cases, the changes occurred within the first six months after radioiodine treatment (Figure 2Figure 2Kaplan–Meier Plots of the Development or Progression of Ophthalmopathy in Patients with Hyperthyroidism Who Were Treated with Radioiodine, Radioiodine and Prednisone, or Methimazole.). The remaining 55 patients with preexisting ophthalmopathy and the remaining 72 patients with no ophthalmopathy at base line had no changes in their eyes (Figure 1). The prevalence of smokers was greater among the patients in whom ophthalmopathy developed or worsened than among those who had no change (83 percent vs. 50 percent, P<0.001).Among the 145 patients treated with radioiodine and prednisone, 50 of the 75 patients who had ophthalmopathy at base line (67 percent; 95 percent confidence interval, 55 to 77 percent) had regression of ophthalmopathy; the remaining 95 patients (25 with and 70 without ophthalmopathy at base line) had no change (Figure 1). No patient in this group had worsening of ophthalmopathy. Among the 148 patients treated with methimazole, 3 of the 74 patients with preexisting ophthalmopathy (4 percent; 95 percent confidence interval, 1 to 11 percent) had improvement in the severity of their eye disease, and 4 patients (3 with and 1 without preexisting ophthalmopathy) had new or worsening ophthalmopathy (3 percent; 95 percent confidence interval, 1 to 7 percent) (Figure 1). The frequency of the development or progression of ophthalmopathy was significantly higher in the radioiodine group than in either the radioiodine–prednisone group or the methimazole group (P<0.001 for both comparisons), but there was no significant difference between the latter two groups (P = 0.12). The frequency of improvement of ophthalmopathy was significantly higher in the radioiodine–prednisone group than in the other two groups (P<0.001 for both comparisons).
Among the 23 patients in the radioiodine group in whom ophthalmopathy developed or worsened, the change was transient (i.e., it lasted for two to three months) in 15 (65 percent) and persistent in 8 (35 percent), 7 of whom had ophthalmopathy at base line. Overall, orbital radiotherapy and high-dose glucocorticoid therapy for new or worsened ophthalmopathy were required by eight patients in the radioiodine group (5 percent; 95 percent confidence interval, 2 to 10 percent), one patient in the methimazole group (1 percent, 95 percent confidence interval, 0 to 4 percent), and none in the radioiodine–prednisone group. The percentages of patients in each group who were euthyroid, hyperthyroid, and hypothyroid at various times did not differ significantly, except that more patients in the methimazole group were euthyroid during the follow-up period (P<0.04) (Table 2Table 2
Thyroid Status in the Three Groups at Base Line, during Follow-up, and in Relation to the Worsening of Ophthalmopathy.). There was no relation between thyroid status and the development or progression of ophthalmopathy.The development or progression of ophthalmopathy in the 23 patients in the radioiodine group involved soft-tissue changes (palpebral edema in 21 patients, conjunctival hyperemia in 19, chemosis in 17, and edema of the caruncle in 19), an increase in proptosis in 18 patients, lid retraction in 17 patients, lagophthalmos in 10 patients, and diplopia in 14 patients (intermittent or inconstant in 6 and constant in 8). The mean ophthalmopathy-activity score and the degree of proptosis increased significantly in these 23 patients (Table 3Table 3
Ocular Findings in the Three Groups before Treatment and One Year Later.). Soft-tissue changes were always associated with an increase in at least two major criteria for ophthalmopathy, and the patient's assessment confirmed the development or worsening of ophthalmopathy in all cases. No changes occurred in the remaining 127 patients in this group (Table 3).The improvement of ophthalmopathy in 50 of the 75 patients in the radioiodine–prednisone group who had eye disease at base line involved soft-tissue changes (palpebral edema in 40, conjunctival hyperemia in 45, chemosis in 39, and edema of the caruncle in 34) and a decrease in proptosis (35 patients). Eye-muscle function improved in the 19 patients who had diplopia before treatment. The mean ophthalmopathy-activity score and the degree of proptosis decreased significantly in these 50 patients (Table 3), and all reported improvement. There were no side effects of prednisone treatment other than the appearance of cushingoid features, which disappeared after prednisone was discontinued.
Discussion
Whether treatment of hyperthyroidism in patients with Graves' disease is associated with the development or progression of ophthalmopathy is the subject of much debate. In some retrospective studies, progression of preexisting eye disease was more common than its development after treatment of hyperthyroidism, although progression was not more common after any one of the three treatments — an antithyroid drug, radioiodine, or thyroidectomy — than after the others.3,8-12 In some other studies, including three prospective studies,6,13,14 radioiodine was associated with progression of ophthalmopathy.13-17 Although available comparative studies are limited, at least one prospective trial15 and two retrospective studies18,19 indicated that progression of ophthalmopathy was more common in patients treated with radioiodine than in those who received the other two treatments. The development or progression of ophthalmopathy after radioiodine therapy might be related to the release of thyroid antigens as a result of radiation injury and to subsequent enhancement of autoimmune responses directed toward antigens shared by the thyroid and the orbit.1 The same mechanism has been postulated to explain the development of ophthalmopathy after irradiation of the neck for nonthyroidal disorders20,21 or after thyroid-destructive processes.22
In this prospective, single-blind, controlled study, we found that radioiodine therapy for Graves' hyperthyroidism was followed by the development or, more often, the progression of ophthalmopathy in patients treated with radioiodine alone, but not in those treated with radioiodine and prednisone; the patients treated with methimazole had no progression of eye disease. The worsening of eye disease was slight and transient in the majority of patients, but it persisted and ultimately required treatment with orbital radiotherapy and high-dose prednisone in a few. Of the three treatments, only the administration of prednisone after radioiodine therapy was associated with amelioration of preexisting eye disease during the one-year follow-up period, thus yielding more favorable results than those in the methimazole group.
How can the effects of radioiodine therapy on Graves' ophthalmopathy be explained? First, in many patients, the onset of ophthalmopathy, or its worsening, if it is already present, is slight and transient, and the condition is likely to be missed unless the patients are examined often. We examined our patients every one to two months not only to detect changes in their eyes but also to correct hypothyroidism promptly, because prompt amelioration of hypothyroidism reduces the likelihood that ophthalmopathy will progress after radioiodine therapy.23 A second explanation might lie in the selection of patients; worsening of ophthalmopathy after radioiodine therapy does not occur in all patients, suggesting that other known risk factors (e.g., smoking24,25) and unknown risk factors contribute to the development or progression of eye disease. In this regard, the varying duration of hyperthyroidism and ophthalmopathy in the different studies might also be a confounding variable.26 Base-line serum thyroid hormone concentrations may be a risk factor, because in one study the development or worsening of ophthalmopathy was more frequent among patients who had higher serum free triiodothyronine concentrations before radioiodine therapy.13 The values in our patients did not vary, but all had been treated with methimazole before randomization.
Because antithyroid-drug treatment is not often followed by the development or progression of ophthalmopathy, it might be argued that patients with ophthalmopathy should be treated with such a drug, while waiting for hyperthyroidism and ophthalmopathy to subside spontaneously. However, antithyroid-drug treatment can be associated with unsatisfactory control of hyperthyroidism and, more important, hyperthyroidism can recur after the withdrawal of therapy.27,28 Persistent hyperthyroidism or its recurrence after the discontinuation of antithyroid-drug therapy could negatively affect the course of ophthalmopathy.16 Thus, we think that it is best to achieve permanent control of hyperthyroidism in patients with ophthalmopathy. Radioiodine accomplishes this well. Although, in the short term, it may have negative effects on eye disease, these are often transient and can be prevented by moderate doses of glucocorticoids.
Presented in abstract form at the 11th International Thyroid Congress, Toronto, September 10–15, 1995.
Source Information
From the Istituto di Endocrinologia (L.B., C.M., F.B., L.M., M.L.T., E.D., G.B.-B., E.M., A.P.) and the Clinica Oculistica (M.N., M.P.B., A.L.), University of Pisa, and the Reparto di Epidemiologia e Biostatistica, Istituto di Fisiologia Clinica, National Research Council (G.R.) — all in Pisa, Italy.
Address reprint requests to Dr. Bartalena at the Istituto di Endocrinologia, University of Pisa, Ospedale Cisanello, Via Paradisa, 3, 56122 Pisa, Italy.
- References
References
1
Burch HB ,Wartofsky L . Graves' ophthalmopathy: current concepts regarding pathogenesis and management. Endocr Rev 1993;14:747-793
Web of Science | Medline2
Prummel MF ,Wiersinga WM ,Mourits MP ,Koornneef L ,Berghout A ,van der Gaag R . Effect of abnormal thyroid function on the severity of Graves' ophthalmopathy. Arch Intern Med 1990;150:1098-1101
CrossRef | Web of Science | Medline3
Sridama V ,DeGroot LJ . Treatment of Graves' disease and the course of ophthalmopathy. Am J Med 1989;87:70-73
CrossRef | Web of Science | Medline4
Marcocci C ,Bartalena L ,Bogazzi F ,Bruno-Bossio G ,Pinchera A . Relationship between Graves' ophthalmopathy and type of treatment of Graves' hyperthyroidism. Thyroid 1992;2:171-178
CrossRef | Web of Science | Medline5
Winsa B ,Rastad J ,Akerstrom G ,Johansson H ,Westermark K ,Karlsson FA . Retrospective evaluation of subtotal and total thyroidectomy in Graves' disease with and without endocrine ophthalmopathy. Eur J Endocrinol 1995;132:406-412
CrossRef | Web of Science | Medline6
Bartalena L ,Marcocci C ,Bogazzi F ,Panicucci M ,Lepri A ,Pinchera A . Use of corticosteroids to prevent progression of Graves' ophthalmopathy after radioiodine therapy for hyperthyroidism. N Engl J Med 1989;321:1349-1352
Full Text | Web of Science | Medline7
Mourits MP ,Koornneef L ,Wiersinga WM ,Prummel MP ,Berghout A ,van der Gaag R . Clinical criteria for the assessment of disease activity in Graves' ophthalmopathy: a novel approach. Br J Ophthalmol 1989;73:639-644
CrossRef | Web of Science | Medline8
Gwinup G ,Elias AN ,Ascher MS . Effect on exophthalmos of various methods of treatment of Graves' disease. JAMA 1982;247:2135-2138
CrossRef | Web of Science | Medline9
Calissendorff BM ,Soderstrom M ,Alveryd A . Ophthalmopathy and hyperthyroidism: a comparison between patients receiving different antithyroid treatments. Acta Ophthalmol (Copenh) 1986;64:698-703
CrossRef | Web of Science | Medline10
Vasquez-Chavez C ,Nishimura Meguro E ,Espinosa Said L ,Delgado Falfari A ,Sainz de Viteri M . Influencia del tratamiento del hipertiroidismo en el curso del exoftalmos. Rev Invest Clin 1992;44:241-247
Web of Science | Medline11
Fernandez Sanchez JR ,Rosell Pradas J ,Carazo Martinez O , et al. Graves' ophthalmopathy after subtotal thyroidectomy and radioiodine therapy. Br J Surg 1993;80:1134-1136
CrossRef | Web of Science | Medline12
Bartley GB ,Fatourechi V ,Kadrmas EF , et al. Chronology of Graves' ophthalmopathy in an incidence cohort. Am J Ophthalmol 1996;121:426-434
Web of Science | Medline13
Tallstedt L ,Lundell G ,Torring O , et al. Occurrence of ophthalmopathy after treatment for Graves' hyperthyroidism. N Engl J Med 1992;326:1733-1738
Full Text | Web of Science | Medline14
Kung AWC ,Yau CC ,Cheng A . The incidence of ophthalmopathy after radioiodine therapy for Graves' disease: prognostic factors and the role of methimazole. J Clin Endocrinol Metab 1994;79:542-546
CrossRef | Web of Science | Medline15
Vestergaard H ,Laurberg P . Radioiodine and aggravation of Graves' ophthalmopathy. Lancet 1989;2:47-47
CrossRef | Web of Science | Medline16
Karlsson FA ,Westermark K ,Dahlberg PA ,Jansson R ,Enoksson P . Ophthalmopathy and thyroid stimulation. Lancet 1989;2:691-691
CrossRef | Web of Science | Medline17
Barth A ,Probst P ,Burgi H . Identification of a subgroup of Graves' disease patients at higher risk for severe ophthalmopathy after radioiodine. J Endocrinol Invest 1991;14:209-212
Web of Science | Medline18
Hetzel BS ,Mason EK ,Wang HK . Studies of serum long-acting thyroid stimulator (LATS) in relation to exophthalmos after therapy for thyrotoxicosis. Australas Ann Med 1968;17:307-311
Medline19
Aron-Rosa D ,Perez R ,Abitbol Y . Malignant exophthalmos after iodine-131 treatment. Mod Probl Ophthalmol 1973;14:432-43420
Wasnich RD ,Grumet FC ,Payne RO ,Kriss JP . Graves' ophthalmopathy following external neck irradiation for nonthyroidal neoplastic disease. J Clin Endocrinol Metab 1973;37:703-713
CrossRef | Web of Science | Medline21
Jackson R ,Rosenberg C ,Kleinmann R ,Vagenakis AG ,Braverman LE . Ophthalmopathy after neck irradiation therapy for Hodgkin's disease. Cancer Treat Rep 1979;63:1393-1395
Medline22
Bartalena L ,Bogazzi F ,Pecori F ,Martino E . Graves' disease occurring after subacute thyroiditis: report of a case and review of the literature. Thyroid 1996;6:345-348
CrossRef | Web of Science | Medline23
Tallstedt L ,Lundell G ,Blomgren H ,Bring J . Does early administration of thyroxine reduce the development of Graves' ophthalmopathy after radioiodine treatment? Eur J Endocrinol 1994;130:494-497
CrossRef | Web of Science | Medline24
Bartalena L ,Martino E ,Marcocci C , et al. More on smoking habits and Graves' ophthalmopathy. J Endocrinol Invest 1989;12:733-737
Web of Science | Medline25
Bartalena L ,Bogazzi F ,Tanda ML ,Manetti L ,Dell'Unto E ,Martino E . Cigarette smoking and the thyroid. Eur J Endocrinol 1995;133:507-512
CrossRef | Web of Science | Medline26
Wiersinga WM ,Prummel MF . Retrobulbar radiation in Graves' ophthalmopathy. J Clin Endocrinol Metab 1995;80:345-347
Web of Science | Medline27
Marcocci C ,Gianchecchi D ,Masini I , et al. A reappraisal of the role of methimazole and other factors on the efficacy and outcome of radioiodine therapy of Graves' hyperthyroidism. J Endocrinol Invest 1990;13:513-520
Web of Science | Medline28
Vitti P ,Rago T ,Chiovato L , et al. Clinical features of patients with Graves' disease undergoing remission after antithyroid drug treatment. Thyroid 1997;7:369-375
CrossRef | Web of Science | Medline
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Dan Yun Chen, Jin Jing, Peter F. Schneider, Tang Hua Chen. (2009) Comparison of the long-term efficacy of low dose 131I versus antithyroid drugs in the treatment of hyperthyroidism. Nuclear Medicine Communications 30:2, 160-168
CrossRef35
Amanda M. Bell, Henry B. Burch. 2009. Hyperthyroidism. , 283-289.
CrossRef36
Kwai Mei Law, George C Woo. (2009) Thyroid disease induced diplopia. Clinical and Experimental Optometry 92:1, 30-33
CrossRef37
Shamasunder H. Acharya, Alison Avenell, Sam Philip, Jennifer Burr, John S. Bevan, Prakash Abraham. (2008) Radioiodine therapy (RAI) for Graves’ disease (GD) and the effect on ophthalmopathy: a systematic review*. Clinical Endocrinology 69:6, 943-950
CrossRef38
Maria Laura Tanda, Adriana Lai, Luigi Bartalena. (2008) Relation between Graves’ orbitopathy and radioiodine therapy for hyperthyroidism: facts and unsolved questions*. Clinical Endocrinology 69:6, 845-847
CrossRef39
M. Underner, S. Hadjadj, M. Beauchant, F. Bridoux, F. Debiais, J.-C. Meurice. (2008) Effets du tabagisme sur la thyroïde, le tube digestif, le rein et l’os. Revue des Maladies Respiratoires 25:10, 1261-1278
CrossRef40
RA Ajjan, AP Weetman. (2008) Techniques to quantify TSH receptor antibodies. Nature Clinical Practice Endocrinology & Metabolism 4:8, 461-468
CrossRef41
Peter Stålberg, Anna Svensson, Ola Hessman, Göran Åkerström, Per Hellman. (2008) Surgical Treatment of Graves’ Disease: Evidence-Based Approach. World Journal of Surgery 32:7, 1269-1277
CrossRef42
Luigi Bartalena, Adriana Lai, Emanuele Compri, Claudio Marcocci, Maria Laura Tanda. (2008) Novel Immunomodulating Agents for Graves Orbitopathy. Ophthalmic Plastic & Reconstructive Surgery 24:4, 251-256
CrossRef43
Brent, Gregory A., . (2008) Graves' Disease. New England Journal of Medicine 358:24, 2594-2605
Full Text44
Bijay Vaidya, Graham R. Williams, Prakash Abraham, Simon H. S. Pearce. (2008) Radioiodine treatment for benign thyroid disorders: results of a nationwide survey of UK endocrinologists. Clinical Endocrinology 68:5, 814-820
CrossRef45
Joseph R. Lutt, Lyndell L. Lim, Pramit M. Phal, James T. Rosenbaum. (2008) Orbital Inflammatory Disease. Seminars in Arthritis and Rheumatism 37:4, 207-222
CrossRef46
Byung-Cheol Lee, Shin-Ik Kang, Young-Min Ahn, Ho-Kyung Doo, Se-Young Ahn. (2008) An Alternative Therapy for Graves' Disease. Biological & Pharmaceutical Bulletin 31:4, 583-587
CrossRef47
Hua Sun, Xu-Feng Jiang, Shu Wang, Hao-Yan Chen, Jiao Sun, Pei-Yong Li, Guang Ning, Yong-Ju Zhao. (2007) 99mTc-HYNIC-TOC scintigraphy in evaluation of active Graves’ ophthalmopathy (GO). Endocrine 31:3, 305-310
CrossRef48
Christopher I Zoumalan, Kimberly P Cockerham, Roger E Turbin, Nicholas J Volpe, Michael Kazim, Raymond S Douglas, Steven E Feldon. (2007) Efficacy of Corticosteroids and External Beam Radiation in the Management of Moderate to Severe Thyroid Eye Disease. Journal of Neuro-Ophthalmology 27:3, 205-214
CrossRef49
Bindu Nayak, Steven P. Hodak. (2007) Hyperthyroidism. Endocrinology & Metabolism Clinics of North America 36:3, 617-656
CrossRef50
Anthony P. Weetman. (2007) Radioiodine treatment for benign thyroid diseases. Clinical Endocrinology 66:6, 757-764
CrossRef51
Wilmar M Wiersinga. (2007) Management of Graves' ophthalmopathy. Nature Clinical Practice Endocrinology & Metabolism 3:5, 396-404
CrossRef52
Ş. Aktaran, E. Akarsu, İ. Erbağci, M. Araz, S. Okumuş, M. Kartal. (2007) Comparison of intravenous methylprednisolone therapy vs. oral methylprednisolone therapy in patients with Graves’ ophthalmopathy. International Journal of Clinical Practice 61:1, 45-51
CrossRef53
E.L. Mazzaferri. (2007) Extensive Thyroidectomy in Graves' Disease. Yearbook of Endocrinology 2007, 196-199
CrossRef54
Miguel Aguirre Sánchez-Covisa. (2006) Tratamiento de la oftalmopatía tiroidea. Endocrinología y Nutrición 53:9, 550-558
CrossRef55
James A. Garrity, Rebecca S. Bahn. (2006) Pathogenesis of Graves Ophthalmopathy: Implications for Prediction, Prevention, and Treatment. American Journal of Ophthalmology 142:1, 147-153.e2
CrossRef56
Carla Amaral de Almeida, Leonardo Vieira Neto, Alexandru Buescu, M??rio Vaisman. (2006) Clinical Evaluation of the Long-Term Response to Intravenous Pulses of Methylprednisolone in Patients With Moderate to Severe Graves Ophthalmopathy. The Endocrinologist 16:4, 193-196
CrossRef57
Domenico Salvatore, Gianfranco Fenzi. (2006) Do glucocorticoids affect outcome in Graves' disease following radioiodine therapy?. Nature Clinical Practice Endocrinology & Metabolism 2:4, 194-195
CrossRef58
Kaare J. Weber, Carmen C. Solorzano, Jane K. Lee, Michael J. Gaffud, Richard A. Prinz. (2006) Thyroidectomy remains an effective treatment option for Graves’ disease. The American Journal of Surgery 191:3, 400-405
CrossRef59
Peter Laurberg, Stig Andersen, Jesper Karmisholt. (2006) Antithyroid drug therapy of Graves’ hyperthyroidism: realistic goals and focus on evidence. Expert Review of Endocrinology & Metabolism 1:1, 91-102
CrossRef60
Ramzi Ajjan, Anthony Weetman. (2006) New insights into antibody-mediated hyperthyroidism. Expert Review of Endocrinology & Metabolism 1:1, 67-81
CrossRef61
Sang June Kim, Byoung Jin Kim, Ha Bum Lee, Angelo Tsirbas, Michael Kazim. (2006) Thyroid Associated Orbitopathy Following Periocular Surgery. Korean Journal of Ophthalmology 20:2, 82
CrossRef62
Sara P Modjtahedi, Bobeck S Modjtahedi, Ahmad M Mansury, Dinesh Selva, Raymond S Douglas, Robert A Goldberg, Igal Leibovitch. (2006) Pharmacological Treatments for Thyroid Eye Disease. Drugs 66:13, 1685-1700
CrossRef63
J. Järhult, C. Rudberg, E. Larsson, H. Selvander, K. Sjövall, B. Winsa, J. Rastad, F.A. Karlsson. (2005) Graves' Disease with Moderate–Severe Endocrine Ophthalmopathy–Long Term Results of a Prospective, Randomized Study of Total or Subtotal Thyroid Resection. Thyroid 15:10, 1157-1164
CrossRef64
S. Dasgupta, M. W. Savage. (2005) Evaluation of management of Graves' disease in District General Hospital: achievement of consensus guidelines. International Journal of Clinical Practice 59:9, 1097-1100
CrossRef65
Luigi Bartalena, Maria Laura Tanda, Fausto Bogazzi, Eliana Piantanida, Adriana Lai, Enio Martino. (2005) An update on the pharmacological management of hyperthyroidism due to Graves’ disease. Expert Opinion on Pharmacotherapy 6:6, 851-861
CrossRef66
Takao Ando, Rauf Latif, TerryF. Davies. (2005) Thyrotropin receptor antibodies: new insights into their actions and clinical relevance. Best Practice & Research Clinical Endocrinology & Metabolism 19:1, 33-52
CrossRef67
Wilmar M. Wiersinga. (2005) The Philosophy of Graves' Ophthalmopathy. Orbit 24:3, 165-171
CrossRef68
S. El-Kaissi, A. G. Frauman, J. R. Wall. (2004) Thyroid-associated ophthalmopathy: a practical guide to classification, natural history and management. Internal Medicine Journal 34:8, 482-491
CrossRef69
M.Sean Boger, Nancy D. Perrier. (2004) Advantages and disadvantages of surgical therapy and optimal extent of thyroidectomy for the treatment of hyperthyroidism. Surgical Clinics of North America 84:3, 849-874
CrossRef70
Elizabeth N Pearce, Lewis E Braverman. (2004) Hyperthyroidism: advantages and disadvantages of medical therapy. Surgical Clinics of North America 84:3, 833-847
CrossRef71
A. De Bellis, S. Perrino, C. Coronella, D. Sansone, G. Ruocco, G. Tirelli, S. Di Martino, M. Conte, G. Bellastella, J. R. Wall, A. Bellastella, A. Bizzarro. (2004) Extraocular muscle antibodies and the occurrence of ophthalmopathy in Graves' disease. Clinical Endocrinology 60:6, 694-698
CrossRef72
Ranjiv Sivanandan, Lay Guat Ng, Lay Wai Khin, Teck Hock Dennis Lim, Khee Chee Soo. (2004) Postoperative endocrine function in patients with surgically treated thyrotoxicosis. Head & Neck 26:4, 331-337
CrossRef73
Michele Marinò, Simonetta Lisi, Aldo Pinchera, Claudio Marcocci, Francesca Menconi, Eugenia Morabito, Marco Macchia, Stefano Sellari-Franceschini, Robert T. McCluskey, Luca Chiovato. (2003) Glycosaminoglycans Provide a Binding Site for Thyroglobulin in Orbital Tissues of Patients with Thyroid-Associated Ophthalmopathy. Thyroid 13:9, 851-859
CrossRef74
Annamaria De Bellis, Antonio Bizzarro, Marisa Conte, Concetta Coronella, Stefano Solimeno, Silvia Perrino, Daniela Sansone, Mariangela Guaglione, Jack R. Wall, Antonio Bellastella. (2003) Relationship between longitudinal behaviour of some markers of eye autoimmunity and changes in ocular findings in patients with Graves' ophthalmopathy receiving corticosteroid therapy. Clinical Endocrinology 59:3, 388-395
CrossRef75
David S Cooper. (2003) Hyperthyroidism. The Lancet 362:9382, 459-468
CrossRef76
Daniel Chun-Hang Wai, Su-Chin Ho, Lay-Leng Seah, Kee-Siew Fong, Daphne Hsu-Chin Khoo. (2003) Severe Graves' Ophthalmopathy After Retrobulbar Anesthesia for Cataract Extraction in a Patient with Mild Stable Thyroid Eye Disease. Thyroid 13:8, 823-826
CrossRef77
Mariacarla Moleti, Filiberto Mattina, Ignazio Salamone, Maria Antonia Violi, Carmelo Nucera, Sergio Baldari, Maria Grazia Lo Schiavo, Concetto Regalbuto, Francesco Trimarchi, Francesco Vermiglio. (2003) Effects of Thyroidectomy Alone or Followed by Radioiodine Ablation of Thyroid Remnants on the Outcome of Graves' Ophthalmopathy. Thyroid 13:7, 653-658
CrossRef78
Caroline B. Terwee, Friedo W. Dekker, Gouke J. Bonsel, Siem H. Heisterkamp, Mark F. Prummel, Lelio Baldeschi, Wilmar M. Wiersinga. (2003) Facial disfigurement: is it in the eye of the beholder? A study in patients with Graves' ophthalmopathy. Clinical Endocrinology 58:2, 192-198
CrossRef79
(2003) References. Thyroid 13:1, 104-126
CrossRef80
Jorg D??tsch, Wolfgang Rascher, Helmuth G. D??rr. (2003) Graves Disease in Childhood. Pediatric Drugs 5:2, 95-102
CrossRef81
I. Bofilias. 2002. , 246-256.
CrossRef82
P. E. Goretzki, B. Lammers, C. Dotzenrath, J. Witte. 2002. , 193-202.
CrossRef83
S. Massoudi, W. Brenner, S. Brandt, W. U. Kampen, E. Henze. 2002. , 239-245.
CrossRef84
Claudio Marcocci, Luigi Bartalena, Michele Marinò, Roberto Rocchi, Barbara Mazzi, Francesca Menconi, Eugenia Morabito, Aldo Pinchera. (2002) Current Medical Management of Graves Ophthalmopathy. Ophthalmic Plastic & Reconstructive Surgery 18:6, 402-408
CrossRef85
LUIGI BARTALENA. (2002) Radioiodine therapy and Gravesʼ ophthalmopathy. Nuclear Medicine Communications 23:11, 1143-1145
CrossRef86
Wilmar M. Wiersinga, Luigi Bartalena. (2002) Epidemiology and Prevention of Graves' Ophthalmopathy. Thyroid 12:10, 855-860
CrossRef87
Michael S. Barakate, Gaurav Agarwal, Tom S. Reeve, Bruce Barraclough, Bruce Robinson, Leigh W. Delbridge. (2002) Total thyroidectomy is now the preferred option for the surgical management of Graves' disease. ANZ Journal of Surgery 72:5, 321-324
CrossRef88
Simonetta Lisi, Michele Marinò, Aldo Pinchera, Barbara Mazzi, Caterina di Cosmo, Stefano Sellari-Franceschini, Luca Chiovato. (2002) Thyroglobulin in Orbital Tissues from Patients with Thyroid-Associated Ophthalmopathy: Predominant Localization in Fibroadipose Tissue. Thyroid 12:5, 351-360
CrossRef89
Petros Perros, Pat Kendall-Taylor. (2002) Medical Treatment for Thyroid-Associated Ophthalmopathy. Thyroid 12:3, 241-244
CrossRef90
Marian E. Ludgate. (2002) Animal Models of Thyroid-Associated Ophthalmopathy. Thyroid 12:3, 205-208
CrossRef91
C. Pavía, J. Villanueva, C. Valls, S. Mañé, J. Cedó. (2002) Radioiodine Therapy for Graves Disease in Adolescents: Analysis of 11 Patients. The Endocrinologist 12:1, 17-19
CrossRef92
A. M.S. Noury, M. R. Stanford, E. M. Graham. (2001) Radioiodine and Gravesʼ ophthalmopathy reconsidered. Nuclear Medicine Communications 22:11, 1167-1169
CrossRef93
Soma C. Jyonouchi, Rosanee W. Valyasevi, Debra A. Harteneck, Charyl M. Dutton, Rebecca S. Bahn. (2001) Interleukin-6 Stimulates Thyrotropin Receptor Expression in Human Orbital Preadipocyte Fibroblasts from Patients with Graves' Ophthalmopathy. Thyroid 11:10, 929-934
CrossRef94
M.K. Gupta, J. Perl, R. Beham, L.R. Sheeler, J.A. Foster, M. Gliga, N. McBride, M.R. Faiman, A.E. Mehta, R. Dattatreya, C. Faiman. (2001) Effect of 131 Iodine Therapy on the Course of Graves' Ophthalmopathy: A Quantitative Analysis of Extraocular Muscle Volumes Using Orbital Magnetic Resonance Imaging. Thyroid 11:10, 959-965
CrossRef95
P. Lind. (2001) Die ablative Therapie der Immunhyperthyreose unter spezieller Berucksichtigung der endokrinen Orbitopathie. Acta Medica Austriaca 28:4, 105-107
CrossRef96
A. Jane Dickinson, Petros Perros. (2001) Controversies in the clinical evaluation of active thyroid-associated orbitopathy: use of a detailed protocol with comparative photographs for objective assessment. Clinical Endocrinology 55:3, 283-303
CrossRef97
Mark F. Prummel, Martin N. Gerding, Frans W. Zonneveld, Wilmar M. Wiersinga. (2001) The usefulness of quantitative orbital magnetic resonance imaging in Graves' ophthalmopathy. Clinical Endocrinology 54:2, 205-209
CrossRef98
Michele Marinò, Simonetta Lisi, Aldo Pinchera, Barbara Mazzi, Francesco Latrofa, Stefano Sellari-Franceschini, Robert T. McCluskey, Luca Chiovato. (2001) Identification of Thyroglobulin in Orbital Tissues of Patients with Thyroid-Associated Ophthalmopathy. Thyroid 11:2, 177-185
CrossRef99
Petra Werga-Kjellman, Jan Zedenius, Leif Tallstedt, Frank Träisk, Göran Lundell, Göran Wallin. (2001) Surgical Treatment of Hyperthyroidism: A Ten-Year Experience. Thyroid 11:2, 187-192
CrossRef100
Weetman, Anthony P., . (2000) Graves' Disease. New England Journal of Medicine 343:17, 1236-1248
Full Text101
J. P. Walsh. (2000) Management of Graves' disease in Australia. Australian and New Zealand Journal of Medicine 30:5, 559-566
CrossRef102
Marian Ludgate, Kerry Starkey. (2000) Progress in our understanding of the pathogenesis of Graves ophthalmopathy. Current Opinion in Endocrinology & Diabetes 7:5, 270-274
CrossRef103
I. M. M. J. Wakelkamp, M. N. Gerding, J.W. C. Van Der Meer, M. F. Prummel, W. M. Wiersinga. (2000) Both Th1- and Th2-derived cytokines in serum are elevated in Graves' ophthalmopathy. Clinical and Experimental Immunology 121:3, 453-457
CrossRef104
Petros Perros. (2000) Anti-thyroid drug treatment before radioiodine in patients with Graves' disease: soother or menace?. Clinical Endocrinology 53:1, 1-2
CrossRef105
Won Bae Kim, Hyun Kyung Chung, Young Joo Park, Do Joon Park, Kazuo Tahara, Leonard D. Kohn, Bo Youn Cho. (2000) The Prevalence and Clinical Significance of Blocking Thyrotropin Receptor Antibodies in Untreated Hyperthyroid Graves' Disease. Thyroid 10:7, 579-586
CrossRef106
K. MacAndie, A.N. Harnett, P. Kyle. (2000) Restoration of Vision by Radiotherapy for Severe, Acute, Steroid-Refractory, Congestive Thyroid Orbitopathy. Clinical Oncology 12:3, 188-191
CrossRef107
Wilmar M. Wiersinga, Mark F. Prummel. (2000) AN EVIDENCE-BASED APPROACH TO THE TREATMENT OF GRAVES' OPHTHALMOPATHY. Endocrinology & Metabolism Clinics of North America 29:2, 297-319
CrossRef108
Luigi Bartalena, Luca Manetti, Maria Laura Tanda, Enrica Dell'Unto, Barbara Mazzi, Roberto Rocchi, Giuseppe Barbesino, Aldo Pinchera, Claudio Marcocci. (2000) Soluble interleukin-1 receptor antagonist concentration in patients with Graves' ophthalmopathy is neither related to cigarette smoking nor predictive of subsequent response to glucocorticoids. Clinical Endocrinology 52:5, 647-651
CrossRef109
Maarten P Mourits, M Loes van Kempen-Harteveld, M Begoña García García, Hans PF Koppeschaar, Lidwine Tick, Caroline B Terwee. (2000) Radiotherapy for Graves' orbitopathy: randomised placebo-controlled study. The Lancet 355:9214, 1505-1509
CrossRef110
Kenneth C Kubis, Helen Danesh-Meyer, Edmund A Pribitkin, Jurij R Bilyk. (2000) Progressive Visual Loss and Ophthalmoplegia. Survey of Ophthalmology 44:5, 433-441
CrossRef111
Manjula K Gupta. (2000) Thyrotropin-receptor antibodies in thyroid diseases: advances in detection techniques and clinical applications. Clinica Chimica Acta 293:1-2, 1-29
CrossRef112
OSAMA SABRI, MICHAEL ZIMNY, MATHIAS SCHRECKENBERGER, PATRICK REINARTZ, ELISABETH OSTWALD, UDALRICH BUELL. (1999) Radioiodine Therapy in Graves' Disease Patients with Large Diffuse Goiters Treated with or without Carbimazole at the Time of Radioiodine Therapy. Thyroid 9:12, 1181-1188
CrossRef113
Steven R. Hamilton. (1999) Neuro-ophthalmology of eye-movement disorders. Current Opinion in Opthalmology 10:6, 405-410
CrossRef114
Marcocci, Bruno-Bossio, Manetti, Tanda, Miccolio, Iacconi, Bartolomei, Nardi, Pinchera, Bartalena. (1999) The course of Graves' ophthalmopathy is not influenced by near total thyroidectomy: a case-control study. Clinical Endocrinology 51:4, 503-508
CrossRef115
Ronald E. Warwar. (1999) New insights into pathogenesis and potential therapeutic options for Graves orbitopathy. Current Opinion in Opthalmology 10:5, 358-361
CrossRef116
YURIKO YAMANO, JUNTA TAKAMATSU, SADAKI SAKANE, KEISUKE HIRAI, KANJI KUMA, NAKAAKI OHSAWA. (1999) Differences Between Changes in Serum Thyrotropin-Binding Inhibitory Antibodies and Thyroid-Stimulating Antibodies in the Course of Antithyroid Drug Therapy for Graves' Disease. Thyroid 9:8, 769-773
CrossRef117
LYNN A. BURMEISTER, RANDALL L. BEATTY, JACK R. WALL. (1999) Malignant Ophthalmopathy Presenting One Week After Radioiodine Treatment of Hyperthyroidism. Thyroid 9:2, 189-192
CrossRef118
. (1998) Graves-oftalmopathie. Medisch-Farmaceutische Mededelingen 36:12, 269-269
CrossRef119
Christine Spitzweg, Bernd Rossmüller, Armin E, Heufelder. (1998) Radioiodine Therapy and Graves' Ophthalmopathy. Thyroid 8:12, 1193-1193
CrossRef120
Nicky J. Leech, Colin M. Dayan. (1998) Controversies in the management of Graves' disease. Clinical Endocrinology 49:3, 273-280
CrossRef121
Alan M McGregor. (1998) Has the target autoantigen for Graves' ophthalmopathy been found?. The Lancet 352:9128, 595-596
CrossRef122
Luigi Bartalena, Claudio Marcocci, Aldo Pinchera. (1998) On the Effects of Radioiodine Therapy on Graves' Ophthalmopathy. Thyroid 8:6, 533-534
CrossRef123
(1998) Therapy for Hyperthyroidism and Graves' Ophthalmopathy. New England Journal of Medicine 338:21, 1546-1547
Full Text124
LEWIS E. BRAVERMAN. (1998) Prevention of Thyroid Eye Disease and Final Conclusions. Thyroid 8:5, 453-453
CrossRef125
Wiersinga, Wilmar M., . (1998) Preventing Graves' Ophthalmopathy. New England Journal of Medicine 338:2, 121-122
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