RAI without glucocorticoids | RAI with oral glucocorticoids | |
No TED (nonsmoker) | Recommend | Recommend against |
No TED (smoker) | Insufficient data to recommend for or against | |
TED present-active and mild | Recommend against | Recommend¶ |
TED present-active and moderate-to-severe or sight-threatening | Recommend against | Recommend against |
TED present-inactive | Recommend | Recommend against |
RAI: radioiodine; TED: thyroid eye disease; ATDs: antithyroid drugs; TRAb: thyrotropin receptor antibodies.
* 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 TED.
¶ The 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 TED deterioration (high TRAb level, smoking) increase the benefit of glucocorticoids in preventing TED deterioration. Poorly controlled diabetes, osteoporosis, psychiatric illness, high risk for infections increase the likelihood of complications from glucocorticoids.