Effects of Thyroidectomy Alone or Followed by Radioiodine Ablation of Thyroid Remnants on the Outcome of Graves' Ophthalmopathy

Abstract

Fifty-five patients with Graves' disease (GD) and mild to moderate Graves' ophthalmopathy (GO) underwent near-total thyroidectomy (Tx). In 16 patients this was followed by a standard ablative dose of (131)I because of the hystologic evidence of differentiated thyroid carcinoma. We retrospectively evaluated whether or not GO activity could be affected by thyroid surgery alone or followed by complete ablation of thyroid tissue. Accordingly, on the basis of clinical activity score (CAS) values prior to thyroidectomy, we identified two groups: group A with active GO (CAS > or = 3; n = 31) and group B with inactive GO (CAS < or = 2; n = 24). CAS values were then recorded at 6, 12, and 24 months after surgery/(131)I ablation. Over the course of the follow-up period, GO became inactive in approximately 70% of group A patients (CAS 4.2 +/- 0.8 at baseline, 2.1 +/- 2.0 at 24 months, p < 0.0001) and became active in 37.5% patients from group B. When we examined GO activity according to the type of treatment used (Tx or Tx and (131)I), the prevalence of inactive GO both short- and long-term, was significantly higher in the group of patients who underwent Tx and (131)I ablation. Therefore, this seems to be a more effective means of inducing and maintaining inactive GO.

THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves’ orbitopathy

“…Finally, RAI can also be administered after surgery to attain total ablation of thyroid tissue, which might be beneficial for its complete removing of thyroid antigen(s) and autoreactive T lymphocytes likely involved in the pathogenesis of GO (1). Indeed, few studies have suggested that total thyroid ablation is more frequently associated with GO improvement than surgery alone (46,47,48,49,50). According to the recently published Italian guidelines on the treatment of hyperthyroidism in patients affected with GD and GO (51), total thyroid ablation may be suggested when trying to achieve earlier inactivation of GO that can be followed, when needed, by prompt rehabilitative surgery.…”

Comparison of Early Total Thyroidectomy with Antithyroid Treatment in Patients with Moderate-Severe Graves' Orbitopathy: A Randomized Prospective Trial

“…On the other hand, ATD treatment is associated with a high relapse rate after drug withdrawal [19], and the continuing thyroid hyperactivity and fluctuations in thyroid hormone and TSH serum levels, during or after ATD treatment might negatively influence the course of GO. Thus, after control of hyperthyroidism with ATD, the thyroid could be surgically ablated while GO is concomitantly managed with pulse corticosteroids [20,21,22,23,24]. Currently, evidence is scant for the superiority of the conservative approach over the surgical approach or vice versa [25].…”

Is Recombinant Human TSH a Trigger for Graves’ Orbitopathy?

“…Total thyroid ablation (radioiodine ablation after thyroidectomy) has been proposed as a means of inducing and maintaining GO inactivity, though this therapeutic strategy for GO remains controversial [15,16,17]. In our 3 cases, radioiodine treatment was given 3 days after the rhTSH at the peak of the TSH (>80 mU/l) without prophylactic steroid treatment.…”