ATA Guidelines Tools

14 Graves' Disease Graves Disease with Orbitopathy 37. Euthyroidism should be expeditiously achieved and maintained in hyperthyroid patients with GO or risk factors for the development of orbitopathy. (S-M) 38. The ATA recommends clinicians advise patients with GD to stop smoking and refer them to a structured smoking cessation program. As both firsthand and secondhand smoking increase GO risk patients exposed to secondhand smoke should be identified and advised of its negative impact. (S-M) 39. In nonsmoking patients with GD without apparent GO, RAI therapy (without concurrent steroids), ATDs or thyroidectomy should be considered equally acceptable therapeutic options in regard to risk of GO. (S-M) 40. In smoking patients with GD without apparent GO, RAI therapy, ATDs, or thyroidectomy should be considered equally acceptable therapeutic options in regard to risk of GO. (W-L) 41. There is insufficient evidence to recommend for or against the use of prophylactic corticosteroids in smokers who receive RAI and have no evidence of GO. (N-In) 42. In patients with Graves' hyperthyroidism who have mild active ophthalmopathy and no risk factors for deterioration of their eye disease, RAI therapy, ATDs and thyroidectomy should be considered equally acceptable therapeutic options. (S-M) 43. In the absence of any strong contraindication to GC use the ATA suggests considering them for coverage of GD patients with mild active GO who are treated with RAI, even in the absence of risk factors for GO deterioration. (W-L) 44. In GD patients with mild GO who are treated with RAI the ATA recommends steroid coverage if there are concomitant risk factors for GO deterioration. (S-M) 45. In patients with active and moderate to severe or sight-threatening GO the ATA recommends against RAI therapy. Surgery or ATDs are preferred treatment options for GD in these patients. (S-L) 46. In patients with inactive GO the ATA suggests RAI therapy can be administered without steroid coverage. However, in cases of elevated risk for reactivation (high TRAb, Clinical Activity Score [CAS] ≥1 and smokers) that approach might have to be reconsidered. (W-L)

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