Dysthyroid orbitopathy after radiotherapy in severe disease

Orbitopatía distifroidea después de yodoterapia en enfermedad de graves

Background: the release of antigens from the thyroid gland after treatment with radioactive iodine, with an increase in thyroid autoantibodies, cross-react between thyroid cells and fibroblasts of the orbit, which leads to infiltration by activated T cells, aggravating preexisting orbitopathy due to Graves' disease. Both hyper and hypothyroidism can exacerbate ocular manifestations. After iodide therapy there is a 3 to 5% risk of ocular disease detectable in patients who did not have orbitopathy. In 16% with detectable ophthalmopathy and 56% with severe before iodotherapy, the ocular findings may worsen. It has been found that postoperative eye changes are transient and depend on risk factors such as smoking, T3 levels before treatment and pre-existing orbitopathy.
Methods: 58 patients were studied for two years with a diagnosis of Graves' disease who underwent iodotherapy and underwent exophthalmometry and quantification of orbitopathy symptoms before, one month and six months after the therapy.
Results: One month after treatment, 13.79% improved exophthalmometry, 62.07% remained the same and 24.14% worsened, and at 6 months 29.31% improved, 50% remained the same and 20 , 69% worsened. This shows improvement of exophthalmometry after 6 months of treatment, with ap = 0.000. Ocular symptoms such as red eye, ocular burning, pruritus, epiphora, foreign body sensation and diplopia were evaluated separately before treatment and at one month and six months after treatment. The findings were statistically significant. Patients who received prednisolone had a tendency to improve ocular symptoms, p = 0.053.
Conclusion: Patients receiving radioactive iodine treatment for Graves' disease show significant improvement or stability of the orbitopathy or a decrease in exophthalmometry in those without orbitopathy prior to iodotherapy. Prednisolone tends to have a favorable influence on the evolution of orbitopathy.

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