Relationship between the management of Graves' disease and the course of Graves' ophthaimopathy:a systematic review / 中华核医学杂志

ABSTRACT

Objective To perform literature search and review on the controversial relationship between therapies of hyperthyroidism due to Graves'disease(GD)and the course of Graves'ophthalmopathy(CA)).Methods We searched the database of MEDLINE(1966-2006.3),EMBASE(1984-2005),Cochrane Library(2006 No.1),CBMdisc(1978.1-2006.4)and CNKI(1994-2006).The methodological quality of the studies selected for review was assessed according to the quality assessment criteria suggested by the Cochrane systematic review guideline.Meta-analysis was performed by RevMan 4.2 software.Results Eight studies were included in the systematic review.Meta-analysis showed that there was statistically significant difference between 131I and other forms of therapy[surgery or antithyroid drugs(ATD)](test value2.31,5.97,3.70,5.55;all P＜0.05)in aggravation of exophthalmos and symptom improvement in patients without receiving thyroxine during the early stage to prevent hypothyroidism.However,there was no statisti cally significant differenee in the above relationship between surgery and ATD therapy in those patients already receiving thyroxine supplement(test value0.27,0.99;all P＞0.05).There were not yet any studies on the impact between early prevention of hypothyroidism after 131I therapy and GO.Conclusions Based on meta-analysis on literature data,if early measures are not performed to prevent hypothyroidism after 131I therapy,it may induce or aggravate GO more frequently than ATD or surgical treatment.Symptomatic relief of GO after 131I therapy is also less effective than the other 2 forms of therapy.Therefore.131I therapy should be delivered carefully in those patients with GO.