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Is Graves Ophthalmopathy Preventable?

April 2003 -- While many patients with Graves' disease, and some with Hashimoto's, have some thyroid eye disease symptoms, no more than 5% have severe ophthalmopathy. Experts aren't clear as to why this is the case, however they suspect that it may be that severe ophthalmopathy and remain to be elucidated. One possible explanation is that nonsevere ophthalmopathy and non-severe ophthalmopathy are separate conditions, or that additional variables contribute to the severity of the condition. This raises the question: is Graves' disease preventable?

Non-preventable risk factors include:

  • Genetic susceptibility
  • Age -- peak age for women is 40-44 and 60-64, and 5 years later in men
  • Gender -- Men have a slightly higher prevalence, particularly older men
Preventable risk factors include:
  • Cigarette smoking -- Current smokers are more likely to develop ophthalmopathy, tend to have more severe cases, and tend to be less responsibe to treatments
  • Thyroid dysfunction -- Careful control of either hyper- or hypothyroidism can result in a more favorable outcome for the ophthalmopathy
  • Radioiodine (RAI) treatment -- tends to cause progression to more severe eye disease in about 15% of patients
The researchers recommended the following preventative measures:
  • Smokers should stop smoking
  • Those who are hyperthyroid should be restored to normal range via antithyroid drugs
  • Those whose hyperthyroidism isn't responding to antithyroid drugs should have RAI
  • Those who are hypothyroid should be restored to normal range via thyroid hormone replacement drugs
  • Those who are having RAI should have glucocorticoid drugs after the RAI
Source: Bartalena, et. Al., "Graves' ophthalmopathy: a preventable disease?", European Journal of Endocrinology, Issue 46, 2002.

FOR MORE INFORMATION ABOUT GRAVES'/HYPERTHYROIDISM

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