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Endocrine Abstracts (2016) 41 EP1073 | DOI: 10.1530/endoabs.41.EP1073


1Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland; 2Department of Pharmacology, Poznan University of Medical Sciences, Poznan, Poland; 3Department of Ophtalmology, Poznan University of Medical Sciences, Poznan, Poland; 4Laboratory of Medical Electrodiagnostics, Department of Health Prophylaxis, Poznan University of Medical Sciences, Poznan, Poland; 5Centre for Endocrinology, Diabetes & Metabolism Institute of Biomedical Research, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; 66Laboratory of Environmental Research, Department of Toxicology, Poznan University of Medical Sciences, Poznan, Poland.

Introduction: Graves ‘Orbitopathy (GO), is an autoimmune disease associated with Graves’ thyrotoxicosis (GT). The therapy is largely dependent on the severity and activity of ocular changes. Additionally, the severity of GO is influenced by exogenous factors, such as thyroid dysfunction, cigarette smoking or radioiodine therapy (RIT). The aim of the study was to indicate how radioiodine therapy (RIT) influences on GO in smoking and non-smoking patients.

Materials and methods: Patients with GO treated in the Departments of Endocrinology in Poznan between March 2014 and October 2014 were included. Ophthalmological signs were evaluated by visual acuity, cover test, tonometry, fundus examination, lid fissure measurement, visual test, Hertel’s exopthalmometer and Hess-Landcaster screen measure. Presence and activity of GO was assessed using standardized scales such as the Clinical Activity Scale (CAS). The study protocol included also measurement of the serum levels of TSH, thyroid hormone, TPO-Abs, Tg-Abs, TSHR-Abs, and urine cotinine. All patients received an identical therapeutic high dose of 800 MBq 131I. Analyses were conducted at baseline, 2 and 6 months after therapy. Data from anamnesis on the tobacco smoking where confirmed by measurement of cotinine in urine.

Results: Statistically significant differences in serum level of TSHR-Abs were found between non-smokers and smokers at 2 (P<0.001) and 6 months after RIT (P<0.0001). In smokers, statistically significant differences in the assessment of the severity of ophthalmopathy were observed. The ophthalmological signs assessed by the CAS scale occurred more intensely in smokers before (P=0.003) and after RIT (P=0.0001). 46.2% of smokers and 4.3% of non-smokers were subsequently upstaged from mild to moderate GO (CAS scale) after 6 months.

Conclusions: Ocular changes occur with higher intensity in the group of smokers. High dose of RAI does not induce exacerbation of ophthalmopathy in non-smokers.

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