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E. Bouzas, P. Karadimas, G. Mastorakos, S. Gerali, D. Koutras; Use of the somatostatin analogue lanreotide to prevent aggravation of Graves’ ophthalmopathy after radioiodine therapy for hyperthyroidism . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5022.
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Purpose: Radioiodine therapy represents a widely used mode of treatment for hyperthyroidism, due to Graves’ disease. This treatment may aggravate the course of the associated ophthalmopathy but this aggravation can be successfully prevented by the concomitant use of glucocorticoids. Given the side effects of glucocorticoids and their counterindications, an alternative treatment modality preventing ophthalmopathy for patients undergoing radioiodine treatment might be useful. Somatostatin analogues (octreotide and lanreotide) have been successfully used in the treatment of Graves’ ophthalmopathy. We evaluated if lanreotide is effective to prevent progression of pre–existing ophthalmopathy in patients with Graves’ disease treated with radioiodine for hyperthyroidism. Methods:Forty consecutive patient with Graves’ disease and mild ophthalmopathy, assigned to receive radioiodine treatment for hyperthyroidism, were included in this prospective, randomised, controlled study. They were randomly assigned in two groups. One group received no preventive therapy. In the other, lanreotide was given (30 mg i.m.) once every 14 days, for a total of 3 administrations. First dose was administered one day before the radioiodine treatment. Patients were evaluated at baseline and at 1, 3, and 6 months for thyroid and ocular function. Results:In the treatment group seven patients (35%) had improvement of the ophthalmopathy and the remaining 13 (65%) had no change. No patient had worsening of the ophthalmopathy. In the control group five patients (25%) had aggravation of the ophthalmopathy, 1 (5%) improved and 14 (70%) had no change. Conclusions:According to prospective studies regarding hyperthyroid patients treated with radioiodine without any additional protective measure, 24–56% of patients with pre–existing ophthalmopathy present aggravation of the ophthalmopathy. In our study, 25% of patients who received no preventive treatment worsened. No patient receiving lanreotide injections preventively showed aggravation, while 35% showed an improvement of their symptomatology at 6 months following radioiodine treatment. Our findings are comparable to those obtained when prevention by corticosteroids is used. The present study demonstrates the efficacy of lanreotide to prevent the aggravation of ophthalmopathy in patients with Graves’ disease, treated with radioiodine for hyperthyroidism.
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