0905hrs Controversies in thyroid eye disease - Michael Kazim, MD
Friday, May 1, 2009 at 9:05AM 
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.
Reader Comments (1)
I am hypothyroid and on Armour. I do take kelp too. I got my thyroid levels correct first and then I did a few iodine patch tests to see if it picked up a deficiency. It showed I was deficient, so I started the kelp. Many people do fine with a little bit of iodine, then there are others that don't. I started out by taking powdered kelp, but the problem with powdered kelp is that there are no dosages. Plus, iodine deficiency is a symptom, not a cause. There are other, more pressing headaches associated with hypothyroidism. Metabolism, for starters, which can play hell with your immune system, and also your mental health. If you look at a nurses' guide, you'll see that thyroid issues can lead to some chemical difficulties in brain/body day-to-day functioning.