source: Thyroid

year: 2018

authors: Perini N, Villagelin D, Santos RB, de Lourdes Pinto W, Fontanesi Oliveira A, Zampieri C, Paranhos Louback H, Santos Caleffi L, Muller Ferreira Tirapani W, Hamilton Romaldini J

Introduction:
Graves’ orbitopathy (GO), the orbital disorder associated with Graves’ disease, presents a wide variety of clinical manifestations, ranging from mild to severe. However, there are only a few studies regarding long term follow-up of patients with GO disease.

Objectives:
Determine GO evolution in patients treated with radioiodine (RAI) or low methimazole (MMI) doses over a 60 month follow–up period.

Methods and Materials:
Two-hundred sixty GO patients were included in the study. GO evolution was determined using the clinical activity score (CAS) and evaluated every six months over 60 months. The improvement criteria were determined by decreases of >2 points. Worsening was determined by increases of >2 points on the CAS scale, and remission was determined by a CAS score equal to zero. Serum thyroid-stimulating hormone, free thyroxine, and thyroid stimulating hormone receptor antibody (TRAb) levels were also determined. The relationship between each of the two treatments for hyperthyroidism and smoking effects on GO changes was evaluated. GO patients were divided according to administered therapy. Group 1 (n = 128) consisted of patients treated with low MMI dose (2.5–10 mg/day). Group 2 (n = 132) consisted of patients treated with RAI (15 millicuries) followed by L-thyroxine.

Results:
In Group 1, mean age and standard deviation (SD) was 40– 12 years, and 80% of patients were female. Seventy-two percent were TRAb-positive, and 31% smoked. In Group 2, mean age was 40– 12 years, and 83% of patients were female. Seventy-six percent were TRAb positive, and 36% were smokers. There were no differences between the two groups. Using Kaplan-Meier curves, GO evolution in non-smoking patients treated with low MMI doses presented a lower chance of worsening GO development and higher chance of GO improvement (p < 0.05 for both curves) when compared with nonsmoking patients treated with RAI. In contrast, in smoking patients, no significant differences between the two groups were noted.

Conclusion:
In non-smoking patients, low MMI dose treatment for Graves’ disease provided better GO evolution than RAI therapy.

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