Influence of Total Thyroidectomy on Orbital Opthalmopathy and Levels of Antithyroid Antibodies in Patients with Graves' Disease

Abstract

3Kierownik: prof. dr hab. M. ZabelGraves' disease is an autoimmune disease. One of the most severe complications of Graves' disease is orbitopathy. The aim of the study was to estimate the influence of total thyroidectomy on the postoperative course of exophthalmus and determine the levels of thyroid antibodies after surgery. Material and methods. During the period between 2002 and 2005, 1514 strumectomies were performed at the I Chair and Department of General, Gastroenterological and Endocrine Surgery, Medical University in Wroclaw. The study included 69 (4.5%) patients, who were operated on because of Graves' disease. Forty-two (60%) of these patients had progressive opthalmopathy and were subjected to total thyroidectomy (35 women and 7 men, mean age was 31 years). The diagnosis of Graves' disease was established on the basis of the clinical evaluation, fT 3 , fT 4 and TSH values, as well as the determination of serum thyroid antibody levels. Every patient was subjected to an opthalmological examination, with measurements of the degree of exopthalmus, as compared to the ATA (American Thyroid Association) scale. Above-mentioned parameters were measured before surgery and 6, 12 and 18 months after total thyroidectomy. Results. Considering patients after total thyroidectomy, exophthalmus did not proceed. In 17 (40%) patients, 2-3 mm of eyeball retraction was noted, mainly during the initial six months. After surgery, a statistically significant reduction of TSH-receptor and anti-TPO antibody values were observed. Conclusions. Total thyroidectomy in patients with Graves' disease and orbital opthalmopathy significantly reduced the progression of orbitopathy. It also leads to the normalization of serum anti-recepor (TRAb) and anti-peroxidase (anti-TPO) antibody levels. Total thyroidectomy is a quick and effective procedure in the hands of an experienced surgeon and should be performed in secondary or tertiary care centers.

2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis

“…However, a comparison of two different surgical approaches (total thyroidectomy vs. subtotal thyroidectomy) for patients with moderate-tosevere GO showed that the eye disease improved during 3 years of follow-up in all patients (546). In another series of 42 patients with progressive GO treated with total thyroidectomy, exophthalmos was stable in 60% of cases and improved in the remainder (547), suggesting that surgery is not detrimental to GO and may be associated with improvement in some patients. Additionally, a more recent study suggests that surgery might lead to a more rapid improvement in GO than ATDs, and it might thus be a better option for patients that are most concerned about GO changes (548).…”

Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists

“…However, a comparison of two different surgical approaches (total thyroidectomy vs. subtotal thyroidectomy) for patients with moderate-to-severe GO showed that the eye disease improved over 3 years of follow-up in all patients (330). In another series of 42 patients with progressive GO treated with total thyroidectomy, exophthalmos was stable in 60% of cases and improved in the remainder (331), suggesting that surgery is not detrimental to GO and may be associated with improvement in some patients. Other studies suggest that ATDs may not adversely impact mild active GO, but do not address severe GO (318).…”

Total Thyroidectomy is Associated with Increased Prevalence of Permanent Hypoparathyroidism

“…Similarly, in the present study they accounted for just 3.5% of all patients, but there were no cases of permanent HPT in this subgroup. There are some literature reports that claim thyroid surgery does not carry a high risk of complications in Graves’ disease, including patients with high titers of the anti-TSH receptor antibodies [ 25 ]. Hallgrimsson et al found that the differences in the incidence of hypocalcemia following total thyroidectomy for Graves’ disease and for nontoxic multinodular goiter were not statistically significant [ 21 ].…”