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Methimazole more effective for Graves’ ophthalmopathy than radioiodine
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Better outcomes for Graves’ ophthalmopathy were found with low-dose methimazole therapy compared with radioiodine treatment, according to recent study findings published in Thyroid.
“This study demonstrates that [radioiodine] treatment even in patients with mild [Graves’ ophthalmopathy] has a negative long-term effect regardless of the stage of the eye disease (progression or stability),” the researchers wrote. “Patients treated with [radioiodine] had a worse [Graves’ ophthalmopathy] outcome with increasing [clinical activity score] values despite initial mild [Graves’ ophthalmopathy] and previous [antithyroid drug] treatment.”
Danilo Villagelin , MD, of Pontifical University Catholic of Campinas and the University Campinas in Brazil, and colleagues evaluated 238 patients with Graves’ disease relapse after discontinuing antithyroid drug therapy for 12 to 24 months to determine the frequency of thyroid dysfunction, quality of life and body weight changes. Participants were assigned radioiodine (RAI) treatment with levothyroxine replacement (n = 114; mean follow-up, 80.8 months) or low-dose (2.5-7 mg/day) methimazole (n = 124; mean follow-up, 71.3 months).
At 12, 24, 36, 48 and 60 months, more participants in the methimazole group had a euthyroid status (P < .001) compared with the RAI group, which had a higher prevalence of thyroid dysfunction (P < .001).
During all periods of follow-up, Graves’ ophthalmopathy deterioration, evaluated by clinical activity score, was greater in the RAI group (P < .0005). During follow-up, there was no improvement in clinical activity score with RAI treatment (24, 36, 48 and 60 months, P < .05 for all).
No significant difference was found between the groups for the 36-item Short Form Health Survey questionnaire results for patients who were euthyroid stable for at least 6 months.
More weight gain was found among the RAI group compared with the methimazole group (P < .005).
“Use of prolonged low-dose [methimazole] treatment may be a viable therapeutic alternative for relapsed [Graves’ disease] patients, particularly in [Graves’ ophthalmopathy] or patients who are opposed to ablative treatment with radioiodine or surgery,” the researchers wrote. – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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