What is the role of radioiodine in thyroid eye disease?
· Firstly, since radioiodine treatment carries a substantial risk of exacerbating pre-existing thyroid eye disease, it should be avoided as far as possible in patients with active or severe ophthalmopathy, in whom medical therapy with a thionamide drug such as carbimazole is preferable. Radioiodine may be used in patients with mild eye disease but adjuvant oral corticosteriods should be prescribed (N Engl J Med 1998; 338: 73-8). · Secondly, patients without clinical evidence of thyroid disease have a small risk of developing ophthalmopathy and a very low risk of developing severe eye disease. It is prudent to warn all patients of this complication, but the risks do not justify denying most patients the benefits of definitive treatment with radioiodine when indicated. In addition, the risks do not justify the routine use of corti-costeroids in patients without ophthalmopathy (BMJ 1999; 319: 68-9). · Thirdly, smoking, a raised serum triiodothyronine concentration, and uncorrected hypothy
