Radioiodine therapy and thyroid-associated orbitopathy: risk factors and preventive effects of glucocorticoids

Whether or not thyroid-associated orbitopathy is exacerbated by radioiodine therapy is a matter of controversy. Several risk factors can be listed: pre-existing active ophthalmopathy, hypothyroidism following radioiodine therapy, elevated T3 levels during radioiodine therapy, recurrent or persisting hyperthyroidism after low-dose radioiodine therapy and smoking. Recent studies and own data demonstrate that worsening of pre-existing thyroid-associated orbitopathy after radioiodine therapy can be prevented by the administration of glucocorticoids. Even in patients without evident ophthalmopathy the prophylactic use of glucocorticoids is in our opinion justified to minimize a small but known risk of the development of ocular symptoms. Larger prospective randomized studies are needed to establish the optimal dose and duration of the required anti-inflammatory therapy.