A 40-year-old woman with Graves disease refractory to antithyroid drugs is being considered for radioactive iodine (RAI) therapy. She has moderate-to-severe active thyroid eye disease (TED). Which statement regarding RAI in this setting is CORRECT?

• A RAI is contraindicated and surgery is the only option
• B RAI improves active TED by reducing thyroid-stimulating immunoglobulins
• C RAI can be given safely with concurrent glucocorticoid prophylaxis to prevent worsening of TED ✓
• D RAI has no effect on the course of TED

Explanation

Active moderate-to-severe thyroid eye disease is a relative contraindication to RAI because RAI can worsen TED by transiently releasing thyroidal antigens and elevating TSI levels. However, if RAI is chosen over surgery in such patients, concurrent systemic glucocorticoids (oral prednisone) are recommended to mitigate the risk of TED exacerbation per European Thyroid Association/EUGOGO guidelines. Surgery or antithyroid drugs are preferred first-line when TED is active and severe.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.