Hello – I don’t recall when I posted that study for gatorgirly, but there was guidance released last year on RAI and TED from the American Association of Clinical Endocrinologists and the American Thyroid Association. Their recommendations are based on whether the patient has visible and active eye involvement, how severe the involvement is, and whether the patient is considered “high risk” for worsening eye involvement. (Smokers and patients who have extremely high T3 or antibody levels are considered “high risk”). For patients with no risk factors and no active eye involvement, the guidance says that all three treatment options (RAI, Anti-Thyroid Drugs, Surgery) are equally acceptable. For patients with mild and active eye involvement, RAI is considered an “acceptable” therapy, although the guidance recommends that patients who are “high risk” should receive steroid therapy concurrently with the RAI treatment. For patients with active and moderate-to-severe or sight-threatening eye involvement, the guidance says that methimazole or thyroidectomy are the preferred treatment options. You can access the full guidance in the “Treatment Options” thread of the announcements section of the forum; the section on RAI and eye involvement starts on page 622 of the journal article; page 30 if you download the guidance as a PDF doc.
Following is a link to the study that I originally mentioned. I don’t know if it has since been replicated, but in the section on RAI, the ATA/AACE guidance notes that post-RAI hypothyroidism is a risk factor for worsening of GO, so there must be some belief among the authors that there is some connection between TED and Post-RAI hypo.(Note on links: if you click directly on the following link, you will need to use your browser's “back” button to return to the boards after viewing, or you will have to log back in to the forum. As an alternative, you can right-click the link and open it in a new tab or new window).http://jcem.endojournals.org/content/90/9/5321.short
Finally, on the in-house RAI procedure, I actually spoke with two doctors at a conference this spring who had installed facilities to be able to administer RAI in their offices. I have no idea, though, what the personnel, safety, and certification requirements are to get something like this set up outside a traditional nuclear medicine facility.