Routine steroid prophylaxis is not yet justified

EDITOR—The relation between treatment with radioiodine and thyroid eye disease, discussed in Walsh et al's editorial, troubles many endocrinologists and patients.1 There have been concerns that the use of radioiodine for thyrotoxicosis due to Graves' disease may be associated with a deterioration in ophthalmopathy, raising the question of whether radioiodine is safe for patients with mild ophthalmic Graves' disease. This question has been addressed recently by Bartalena et al, who showed that there is a small but significant risk of deterioration in mild ophthalmopathy after the use of radioiodine and that this risk may be reduced by simultaneous administration of systemic glucocorticoids.2

Walsh et al go further and advocate that high dose prednisone, as used in Bartalena et al's trial, should be used routinely in all patients with mild ophthalmopathy who are to receive radioiodine, to reduce the risk of deterioration in eye disease. Surely …