How Should Hyperthyroidism Be Managed in Patients with Graves' Ophthalmopathy?
R80. Euthyroidism should be expeditiously achieved and maintained in hyperthyroid patients with Graves' ophthalmopathy or risk factors for the development of ophthalmopathy. 1/++0
R81. In nonsmoking patients with Graves' hyperthyroidism who have no clinically apparent ophthalmopathy, 131I therapy without concurrent steroids, methimazole or thyroidectomy should be considered equally acceptable therapeutic options. 1/++0
R82. Clinicians should advise patients with GD to stop smoking and refer them to a structured smoking cessation program. Patients exposed to secondhand smoke should be identified and advised of its negative impact. 1/++0
R83. In patients with Graves' hyperthyroidism who have mild active ophthalmopathy and no risk factors for deterioration of their eye disease, 131I therapy, methimazole, and thyroidectomy should be considered equally acceptable therapeutic options. 1/++0
R84. Patients with Graves' hyperthyroidism and mild active ophthalmopathy who have no other risk factors for deterioration of their eye disease and choose radioactive iodine therapy should be considered for concurrent treatment with corticosteroids.2/++0
R85. Patients with Graves' hyperthyroidism and mild active ophthalmopathy who are smokers or have other risk factors for Graves' ophthalmopathy and choose radioactive iodine therapy should receive concurrent corticosteroids. 1/++0
R86. Patients with Graves' hyperthyroidism and active moderate-to-severe or sight-threatening ophthalmopathy should be treated with either methimazole or surgery. 1/+00
R87. In patients with Graves' hyperthyroidism and inactive ophthalmopathy, the task force suggests that 131I therapy without concurrent corticosteroids, methimazole, and thyroidectomy are equally acceptable therapeutic options. 2/++0