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.