#3 Med Refs V RAI

[Guest guest]

This is one long medical reference all about EYES. Sorry it is so long!

I've been doing this for the 20 reasons V RAI thing, but I think it's

interesting anyway...

MY EXPLAINATION:

In the book, “Graves’ disease, Pathogenesis and Treatment” edited by Basil

Rapoport and M. McLachlan, published 2000 - there is an entire

chapter called “RAI Therapy and GRAVES OPHTHALMOPATHY” by Luigi Bartalena,

Claudio Marcocci and Aldo Pinehera which (in my opinion) is an incredible

example of the way conventional medicine clings to a particular way of doing

things, even in the face of facts and figures which clearly show there might

be a better way. I think it is alright to quote it at length here – it’s in

the public domain by being published so surely we can quote it without

getting into copyright trouble??? I hope no angry scientists come after me

- I'm just a pleb trying to understand!

The writer here is arguing the opposite of what makes sense to me, if you

see what I mean (the writer is for RAI!), but I thought some of the

information and references the writer uses, were more useful for arguing

against RAI in patients with eye disease or a history of smoking!

Here are the concluding remarks, from that chapter MY OWN COMMENTS ARE IN

CAPTIALS!

From “Graves’ disease, Pathogenesis and Treatment edited by Basil Rapoport

and M. McLachlan.

Page 284-285:

“In a recent survey of European endocrinologists, the selected modality of

treatment of recurrent hyperthyroidism after antithyroid drug therapy was

thyroidectomy in 43% of cases, a second course of antithyroid drugs in 32%

of cases and radioiodine in only 25% of cases (46: Weetman A, Wiersinga WM

1998 Current management of thyroid associated ophthalmopathy in Europe.

Results of an international survey. Clin Endocrinal. (Oxf) 49: 21-28). In

other words, when ablative therapy was selected, the preference was surgery

rather than radioiodine therapy, suggesting that the possible negative

effects of RAI might modify the attitude of many endocrinologists as to the

use of RAI therapy in patients with clinically evident eye disease.

(IMAGINE THAT!) We do not share the view that RAI therapy should be avoided

in patients with ophthalmopathy (BUT NOT FAVOURING RAI DUE TO EYE DISEASE,

IS A VALID MEDICAL OPINION ELSEWHERE IN THE WORLD) because progression of

the ophthalmopathy does not occur in the majority of cases and can easily be

prevented by concomitant prednisone therapy (UNLESS OF COURSE THE PATIENT IS

RESISTENT TO THE IDEAS OF ANY RISK OF WORSENING EYE DISEASE, OR OF

SUBJECTING THEMSELVES TO YET MORE DRUGS IF THAT HAPPENS) (ref 30 Bartalena

L, Marcocci C, Bogazzia F, Panicucci M, Lepri A, Pinchera A 1989 Use of

corticosteroids to prevent progression of Graves’ ophthalmopathy after

radioiodine therapy for hyperthyroidism. N Engl J Med. 321: 1349 – 1352),

(REF 47 Baralena L, Marcocci C, Pnchera A, 1998 Therapy for hyperthyroidism

and Graves” ophthalmopathy. N Engl J Med 338: 1546-1547 (Letter)) (Table 2).

In addition, ablation of the thyroid might in the long run prove useful

for the long-term outcome of eye disease, as a consequence of antigen

deprivation and removal of intrathyroidal autoreactive T Lymphocytes. (9

Marcocci C, Bartalena L, Pinchera A 1998 Ablative or non-ablative therapy

for Graves’ hyperthyroidism in patients with ophthalmopathy? J Endocrinal

Invest 21: 468-471) (48 De Groot LJ 1997 Radioiodine and the immune system

Thyroid 7: 259-264) (IS ANYONE AWARE OF THIS “NOT YET PROVEN” THEORY? I

HAD THOUGHT THE OPPOSITE WAS TRUE? THE MOST RECENT REF ON THIS IN 1998 – I

WONDER IF THEY HAVE PROVEN THIS YET?)

“To summarise, radioiodine treatment seems to be associated with possible

progression of pre-existing ophthalmopathy (4: Baralena L, Marcocci C,

Bogazzi F, et al. 1998 Relation between therapy for hyperthyroidism and the

course of Graves’ ophthalmopathy. N Engl J Med. 338: 73-78; 30 As Above;

31: 1992, N Engl J Med 326: 1733-1738); this is more likely in smokers (36:

Bartalena L Marcocci C, Tanda ML, et al. 1998 Cigarette smoking and

treatment outcomes in Graves’ ophthalmopathy. Ann Intern Med 129: 632-635).

Progression does not occur in the majority of patients and, most

important, can easily be prevented by concomitant glucocorticoid treatment

(4 As Above, 30 As Above). Therefore, this risk of progression should not

be taken as an argument to avoid or postpone RAI treatment in hyperthyroid

patients for whom such a treatment is indicated (QUITE RIGHT! EYE PROBLEMS

ARE ONLY ONE OF MANY REASONS FOR AVOIDING RAI!!). On the contrary, we

favour such a treatment, because, even though this remains to be proven, RAI

thyroid ablation might in the long term be beneficial for eye disease.

(WOW!) Accordingly, in patients with non-severe ophthalmopathy the use of

antithyroid drugs or thyroidectomy for hyperthyroidism does not require

anything but local measures for the ophthalmopathy, whereas selection of RAI

for the management of thyroid hyperfunciton should be accompanied by

administration of intermediate-dose glucocorticoid (Table 3). In patients

with severe Graves’ ophthalmopathy, appropriate therapeutic approaches for

eye disease should promptly be taken independently of the treatment selected

for hyperthyroidism.” (I GUESS THIS IS JUST WHERE CONVENTIONAL MEDICINE IS

AT, AND THIS IS WHY YOU MIGHT START OFF WITH ONE PROBLEM, BUT END UP WITH A

FEW OTHERS WHICH ARE THE CONSEQUENCE OF TREATING THE FIRST ONE. I

UNDERSTAND WHY THIS HAPPENS WITH GD BECAUSE THYROTOXICOSIS IS SO

UNCOMFORTABLE AND CAN BE LIFE THREATENING, SO THAT THE BENEFITS OF TREATMENT

OUTWEIGH THE RISK OF NOT TREATING... BUT IF THERE ARE ALTERNATIVES WHICH ARE

MORE FRIENDLY TO THE WHOLE PATIENT - WHY ISN'T CONVENTIONAL MEDICINE

INTERESTED IN THESE?)

I know that's very long. I'm afraid I have just been looking up things

rather than compiling them into any order RE the top 20 list... I might give

it a rest for a while!!

Take care all

DAWN ROSE

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