0905hrs Controversies in thyroid eye disease - Michael Kazim, MD

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Does radioactive iodine have influence on eye disease

role of orbital readiotheraphy and orbital decompression.

I125 RAI a leading mode of therapy in the world.

Trend to completely ablate gland instead of achieving euthyroid state.

Takes up to 3 months

1997 study,does RAI cause orbitopathy

Can steroids prevent progression orbitopathy?

- if don't treat most would get worse anyway, so no control group

Does RAI promote orbitopathy?

- prospective study 443 patients with mild TED (thyroid orbitopathy)

RAI Tx in smokers increases risk of progressive disease - VERY IMPORTANT - by 6 -23%

Smoking also makes medical Tx much less successful.

Avoid RAI in high risk groups (smokers and 4 other criteria...see on-line talk once posted)

If must Tx high risk patient - completely ablate and predose with steroid

RAI studies

- 1991 Donaldson, unclassified disease stage 95% arrested progression, 76% eliminated steroids

- gave data of speakers' own study next

-other studies over the years

- orbital radiotherapy in big Mayo study used stable patients to reach conclusion that RAI no benefit

RAI works for compressive optic neuropathy in acute phase - IMPORTANT

Not effective in others.

Next discusses surgical decompression procedures...

- fatty decompression, if remove enough volume, get effect

- speaker presented own results in 88 orbits

- big proptosis patients get more effect; less effective if much is muscle expansion as the cause

- motility shown to improve

Talks ends 0950hrs.