15
Table 8. Use of Oral Glucocorticoids for Prevention of
Graves' Orbitopathy Development or Progression
When Radioactive Iodine is Used to Treat Graves'
Hyperthyroidism
a
Recommendation
RAI without
glucocorticoids
RAI with oral
glucocorticoids
No GO (nonsmoker) 39 Recommend Recommend
against
No GO (smoker) 41 Insufficient data
to recommend
for or against
GO present-active
and mild (risk factors
absent)
43
Acceptable
b
Acceptable
b
GO present-active
and mild (risk factors
present)
44 Recommend
against
Recommend
GO present-active and
moderate-to-severe or
sight-threatening
45 Recommend
against
Recommend
against
GO present-inactive 46 Recommend Recommend
against
a
ATDs or thyroidectomy are also recommended treatment options in each of these scenarios, and
they are the preferred choice of therapy in patients with active and moderate-to-severe or sight-
threatening GO.
b
e decision regarding use of concurrent glucocorticoids should be made in light of the risk-
benefit ratio relative to the patient's overall health. Risk factors for GO deterioration (high TRAb
level, smoking ) increase the benefit of glucocorticoids in preventing GO deterioration. Poorly
controlled diabetes, osteoporosis, psychiatric illness, high risk for infections increase the likelihood
of complications from glucocorticoids.
