Prevention of thyroid associated-ophthalmopathy in children and adults: current views and management of preventable risk factors.

Primary, secondary and tertiary prevention are defined according to the timing of the preventive intervention in the natural history of a disease. Secondary prevention in Graves' ophthalmopathy (GO) is challenging in the absence of reliable specific serum markers for subclinical GO that would allow an early diagnosis. Some risk factors for occurrence or progression of GO have been identified. Cigarette smoking, thyroid dysfunction and radioactive iodine (RAI) are known preventable risk factors. The list is probably much longer, and future research should be aimed at identifying more. Smoking cessation, restoration of euthyroidism by antithyroid drugs or L-thyroxine, glucocorticoid coverage after RAI or deferring RAI until the eye disease is inactive, may prevent progression of GO. Passive smoking seems to exacerbate autoimmune thyroid disease (AITD) in general, and may have a deleterious effect on childhood GO in particular, therefore avoidance of passive smoking is likely to be beneficial.