Effects of Total Thyroid Ablation Versus Near-Total Thyroidectomy Alone on Mild to Moderate Graves’ Orbitopathy Treated with Intravenous Glucocorticoids

Menconi, Francesca; Marinò, Michele; Pinchera, Aldo; Rocchi, Roberto; Mazzi, Barbara; Nardi, Marco; Bartalena, Luigi; Marcocci, Claudio

doi:10.1210/jc.2006-1800

Cited by 116 publications

(83 citation statements)

References 19 publications

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“…Is there a relationship between the modality of treatment for hyperthyroidism and the course of GO? † Antithyroid drug (ATD) therapy (27,30,33) and thyroidectomy do not affect the course of GO (26,(34)(35)(36), although the role of the latter requires further investigation. † No particular ATD or regimen, nor any type of thyroidectomy (subtotal or total) has been demonstrated to have any advantages in terms of outcome of GO.…”

Section: Management Of Hyperthyroidism In Patients With Gomentioning

confidence: 99%

Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO

Bartalena¹,

Baldeschi²,

Dickinson³

et al. 2008

European Journal of Endocrinology

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628

476

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Section: Management Of Hyperthyroidism In Patients With Gomentioning

confidence: 99%

Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO

Bartalena¹,

Baldeschi²,

Dickinson³

et al. 2008

European Journal of Endocrinology

Self Cite

628

476

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“…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.…”

Section: Current Guidelines For Treatment Of Thyroid Dysfunction In Pmentioning

confidence: 99%

“…Treatment effectiveness much depends on interindividual variability, but this does not seem to be related to polymorphisms of the GC receptor (56). Intravenous pulsed methylprednisolone is more effective (14,46,57,61) and has a better safety profile compared with oral prednisone (60,61,62,63,64,65). Different treatment schedules have been used, with cumulative doses ranging from 4.5 to 12 g and occasionally associated with oral GC interpulse or at the end of the protocol (3,14,54,55,56,57,58,59).…”

Section: Glucocorticoidsmentioning

confidence: 99%

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

Campi

Vannucchi

Salvi

2016

European Journal of Endocrinology

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Management of Graves' orbitopathy (GO) must be based on the correct assessment of activity and severity of the disease. Activity is usually assessed with the Clinical Activity Score, whereas severity is classified according to a European Group On Graves' Orbitopathy (EUGOGO) consensus statement as mild, moderate-to-severe, and sight-threatening. Myopathic and chronic congestive forms are uncommon clinical presentations of GO. Restoration and maintenance of stable euthyroidism are recommended in the presence of GO. In moderate-to-severe disease, steroids have been widely employed and have shown to possess an anti-inflammatory activity, but about 20 -30% of patients are not responsive and present recurrence. Some novel immunosuppressors have already been employed in clinical studies and have shown interesting results, although the lack of randomized and controlled trials suggests caution for their use in clinical practice. Potential targets for therapy in GO are the thyroid-stimulating hormone and the insulin-like growth factor 1 receptor on the fibroblasts, inflammatory cytokines, B and T cells, and the PIK3/mTORC1 signaling cascades for adipogenesis. A recent open study has shown that tocilizumab, an anti-sIL-6R antibody, inactivates GO. Consistent reports on the efficacy of rituximab have recently been challenged by randomized controlled trials. As the main goal of treatment is the well-being of the patient, the therapeutic strategy should be addressed to better suit the patient needs, more than improving one or more biological parameters. The increasing availability of new therapies will expand the therapeutic options for GO patients and allow the clinician to really personalize the treatment to better suit the patients' personal needs.

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“…This observation is consistent with bibliographic data, a b c according to which glucocorticoid excess increases the release of thyroid hormones. Literature data demonstrate that the thyroid gland is sensitive to glucocorticoid excess (Martino et al 2001;Menconi et al 2007;Nadolnik 2012). Some results demonstrate that fluocinolon treatment effects hormone-producing pituitary cells, especially somatotrop, kortikotrop, gonadotrop and tireotrop cells.…”

Section: Histological Studies Of the Thyroid Gland In Control And Trementioning

confidence: 99%

Has the Fluocinolon-acetonid N ointment any effect on the kidneys and the thyroid gland structure and function?

Kis¹,

András²

2017

Studia UBB Biologia

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SUMMARY.Besides the naturally occurring glucocorticoids, there are many other synthetically produced glucocorticoids: dexamethasone, prednisolone, triamcinolone, triamcinolone acetonide, flumetazon, methyl prednisone and methylprednisolone. Corticosteroids are administered intravenously, orally, through inhalation directly onto the inflamed organ, eye drops and by applying skin ointments. Although long term use has its undesirable effects, e.g. high blood pressure, heart failure, diabetes and renal failure. Fluocinolon-acetonid N ointment is a synthetic derivate of the adrenocortical hormone, which is used for medical treatment purposes in dermatology. We also use it in our homes, mostly due to its anti-inflammatory effect, in the treatment of itching, and also in the acute keratosis. It is highly effective in serious, non contagious, dry skin inflammations, such as atopic eczema, seborrheic dermatitis, psoriasis, dermatitis or even in allergic reactions. In prolonged usage due to its liposoluble properties, it is easily absorbed into the bloodstream, which increases the chances of having side effects. The main objective of this study is to analyze the side effects of glucocorticoid excess when treatment is done with Fluocinolon-acetonid N ointment, to see if it has any effect on organs which have an important role in maintaining basal metabolism such as kidneys and thyroid gland. Our results demonstrate that fluocinolon treatment affects the structure and the function of kidneys and thyroid gland.

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Effects of Total Thyroid Ablation Versus Near-Total Thyroidectomy Alone on Mild to Moderate Graves’ Orbitopathy Treated with Intravenous Glucocorticoids

Abstract: Compared with thyroidectomy alone, TTA is followed by a better outcome of GO in patients given iv GC. Whether TTA maintains this advantage in the long-term remains to be established.

Cited by 116 publications

References 19 publications

Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO

Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO

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

Has the Fluocinolon-acetonid N ointment any effect on the kidneys and the thyroid gland structure and function?

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