The course of Graves' ophthalmopathy is not influenced by near total thyroidectomy: a case‐control study

Marcocci, Claudio; Bruno-Bossio, G.; Manetti, Luca; Tanda, Maria Laura; Miccoli, Paolo; Iacconi, Pietro; Bartolomei, Mp; Nardi, Marco; Pinchera, Aldo; Bartalena, Luigi

doi:10.1046/j.1365-2265.1999.00843.x

Cited by 92 publications

(55 citation statements)

References 34 publications

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“…Likewise, as also recently shown by a prospective casecontrol study, near-total thyroidectomy is not associated with substantial variations in ocular conditions (11).…”

Section: Introductionsupporting

confidence: 75%

Controversies in radioiodine therapy: relation to ophthalmopathy, the possible radioprotective effect of antithyroid drugs, and use in large goitres

Bonnema

Bartalena

Toft

et al. 2002

European Journal of Endocrinology

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In routine use for more than 50 years, radioiodine ( 131 I) is generally considered safe and devoid of major side effects. Therefore, it is surprising that relatively many aspects of radioiodine therapy are controversial, as illustrated by recent international questionnaire studies. Our review aims at highlighting three of these areas -namely, the influence of 131 I on the course of Graves' ophthalmopathy, the possible radioprotective effects of antithyroid drugs, and the use of 131 I in large goitres. 131 I therapy carries a small (but definite) risk of causing progression of Graves' ophthalmopathy. Identification of risk factors (thyroid dysfunction, high level of thyroid-stimulating hormone (TSH) receptor antibodies, cigarette smoking) allows the identification of patients at risk and the institution of concomitant glucocorticoid treatment, thereby hindering progression of eye disease.On the basis, largely, of retrospective data, it appears that carbimazole (or methimazole), if stopped 3-5 days before treatment, does not influence the outcome of 131 I therapy. Simultaneous thyrostatic medication most probably reduces the efficacy of 131 I, as does restarting it within 7 days. Propylthiouracil seems to have a more prolonged radioprotective effect than carbimazole.Surgery is the treatment of first choice in patients with a large goitre. However, in the case of patient ineligibility or preference, 131 I therapy may be an option. The treatment has a favourable effect on tracheal compression and inspiratorycapacity, but the reduction in thyroid volume is only 30-40%. Inpatient treatment, necessitated by the large doses, makes the treatment cumbersome.Controversy related to radioiodine therapy is mainly based on the lack of adequate prospective randomised studies comparing efficacy, side effects, cost and patient satisfaction.

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“…Likewise, as also recently shown by a prospective casecontrol study, near-total thyroidectomy is not associated with substantial variations in ocular conditions (11).…”

Section: Introductionsupporting

confidence: 75%

Controversies in radioiodine therapy: relation to ophthalmopathy, the possible radioprotective effect of antithyroid drugs, and use in large goitres

Bonnema

Bartalena

Toft

et al. 2002

European Journal of Endocrinology

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“…We recently reviewed the effects of near-total thyroidectomy in a case-control prospective study involving 30 patients with mild or no ophthalmopathy (230). Our results confirm that surgery has no relevant role in the progression of GO, which occurred only in one patient (who had preexisting ophthalmopathy) (230).…”

Section: Thyroidectomymentioning

confidence: 54%

Management of Graves' Ophthalmopathy: Reality and Perspectives

Bartalena¹

2000

Endocrine Reviews

299

351

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Graves' ophthalmopathy is an debilitating disease impairing the quality of life of affected individuals. Despite recent progress in the understanding of its pathogenesis, treatment is often not satisfactory. In mild cases, local therapeutic measures (artificial tears and ointments, sunglasses, nocturnal taping of the eyes, prisms) can control symptoms and signs. In severe forms of the disease (3-5%), aggressive measures are required. If the disease is active, high-dose glucocorticoids and/or orbital radiotherapy, or orbital decompression represent the mainstay of treatment. If the disease is severe but inactive, orbital decompression is preferred. Novel treatments such as somatostatin analogs or intravenous immunoglobulins are under evaluation. Rehabilitative (extraocular muscle or eyelid) surgery is often needed after treatment and inactivation of eye disease. Correction of both hyper-and hypothyroidism is crucial for the ophthalmopathy. Antithyroid drugs and thyroidectomy do not influence the course of the ophthalmopathy, whereas radioiodine treatment may cause the progression of preexisting ophthalmopathy, especially in smokers. The exacerbation, however, is prevented by glucocorticoids. In addition, thyroid ablation may prove beneficial for the ophthalmopathy in view of the pathogenetic model relating eye disease to autoimmune reactions directed against antigens shared by the thyroid and the orbit.

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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

626

476

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The course of Graves' ophthalmopathy is not influenced by near total thyroidectomy: a case‐control study

Abstract: Treatment of Graves' hyperthyroidism with near-total thyroidectomy in patients with non-severe or absent pre-existing ophthalmopathy is not associated in the short term with significant effects on the course of ophthalmopathy.

Cited by 92 publications

References 34 publications

Controversies in radioiodine therapy: relation to ophthalmopathy, the possible radioprotective effect of antithyroid drugs, and use in large goitres

Controversies in radioiodine therapy: relation to ophthalmopathy, the possible radioprotective effect of antithyroid drugs, and use in large goitres

Management of Graves' Ophthalmopathy: Reality and Perspectives

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

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