IDENTIFICATION OF A SUBGROUP OF GRAVES-DISEASE PATIENTS AT HIGHER RISK FOR SEVERE OPHTHALMOPATHY AFTER RADIOIODINE

We have analyzed retrospectively the records of 89 patients with Graves' disease who were treated with radioiodine between 1980-88 and whose ophthalmopathy was recorded in a uniform manner initially and after 5 and 12 months. Moreover information on progression of eye disease was obtained by telephone for all patients after an average of 72 months. Pretreatment endocrine ophthalmopathy (class greater-than-or-equal-to 1 of classification of American Thyroid Association) was present in 34% of the patients. Eight patients developed proptosis over 20mm, 7 patients severe ophthalmopathy (classes 4 to 6), 5 patients required special treatment for eye disease. Among the 30 patients with initial ophthalmopathy, severe ophthalmopathy (5 of 30; p < 0.05) and proptosis > 20mm 16 of 30; p < 0.05) developed in significantly more cases than in patients with no pretreatment ophthalmopathy. The data suggest that hyperthyroid patients with pretreatment ophthalmopathy are at risk for developing severe ophthalmopathy after I-131 treatment.