Ablative or non-ablative therapy for Graves' hyperthyroidism in patients with ophthalmopathy?

In our view there are no properly controlled trials which support a beneficial effect on ophthalmopathy from surgical or radioiodine-based deliberate ablation for hyperthyroidism. The theoretical basis for this approach can be questioned and we still know too little about the pathogenesis of ophthalmopathy to draw any firm conclusions about the likely effects of ablation. There are established risks with ablation. Like the majority of European thyroidologists, we prefer antithyroid drugs for the initial treatment of hyperthyroidism complicated by Graves’ ophthalmopathy and individualise treatment for recurrent hyperthyroidism based on the patient’s preference, but do not recommend ablation routinely in presence of eye signs.