The effect of subtotal thyroidectomy on Graves' ophthalmopathy

Levitt, Michael D.; Edis, Anthony J.; Agnello, Ross; McCormick, C. C.

doi:10.1007/bf01655858

Cited by 15 publications

(11 citation statements)

References 23 publications

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“…In the latter group, the ablation of residual thyroid tissue was associated with a significant improvement of eye manifestations. A beneficial effect of total thyroid ablation (surgery, radioiodine, or both) on the course of ophthalmopathy has been confirmed by some (56)(57)(58) but not all authors (38,(59)(60)(61), even though a tendency toward improvement more often followed ablative therapy with thyroid surgery than with radioiodine ( One of the main problems in evaluating the role of thyroid ablation on the course of ophthalmopathy is the difficulty of defining ablation. In fact, even in patients developing severe hypothyroidism following total thyroidectomy or radioiodine administration, residual thyroid tissue frequently can be demonstrated by thyroid scan.…”

Section: Thyroidectomymentioning

confidence: 92%

“…Ablation of thyroid tissue is not a standard procedure for treating Graves' hyperthyroidism, and subtotal thyroidectomy generally is reserved only for a minority of patients (those with large goiters or with relapsing hyperthyroidism at a young age). Several studies (30,36,52,59,63) have tried to ascertain whether, as suggested by Catz and Perzik (55), subtotal thyroidectomy may be followed by a worsening of ophthalmopathy. As indicated in Table 3, it is difficult to draw a definite conclusion, and no study has confirmed the constant worsening observed by Catz and Perzik (55).…”

Section: Thyroidectomymentioning

confidence: 99%

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Relationship Between Graves' Ophthalmopathy and Type of Treatment of Graves' Hyperthyroidism

Marcocci

Bartalena²,

Bogazzi³

et al. 1992

Thyroid

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The relationship between the treatment of Graves' hyperthyroidism and the course of ophthalmopathy is rather unclear. Antithyroid drugs may improve eye manifestations, possibly by restoring normal thyroid function and reducing orbit-directed autoimmune reactions, whereas ophthalmopathy may worsen after radioiodine administration or thyroidectomy. This might occur because of a treatment-related release of thyroid antigens and activation of the autoimmune response that might involve the orbit. On the other hand, some authors suggest that complete thyroid ablation, either by radioiodine or surgery, might be beneficial for ophthalmopathy. However, reported effects of radioiodine and thyroidectomy on Graves' ophthalmopathy are conflicting. This may be due, at least in part, to the retrospective feature of most studies and the lack of precise evaluation of ocular involvement. Two prospective studies were performed in which patients with Graves' disease with mild or no ophthalmopathy were randomly assigned to treatment by radioiodine or subtotal thyroidectomy alone or in association with systemic glucocorticoids. Both treatments were followed by a progression of pre-existing mild ophthalmopathy in a substantial proportion of cases: glucocorticoids prevented such an exacerbation. Ophthalmopathy did not develop in patients without clinical evidence of eye disease prior to therapy. Therefore, it is recommended that a course of glucocorticoids be instituted concomitantly with radioiodine therapy or thyroidectomy in Graves' patients with some degree of ocular involvement.

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Section: Thyroidectomymentioning

confidence: 92%

Section: Thyroidectomymentioning

confidence: 99%

Relationship Between Graves' Ophthalmopathy and Type of Treatment of Graves' Hyperthyroidism

Marcocci

Bartalena²,

Bogazzi³

et al. 1992

Thyroid

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“…For those with relapsed GD after an adequate course of ATD, the decision for either RAI or thyroidectomy mostly depends on the presence of absolute or relative surgical indication. Thyroidectomy has gained an increasing role over RAI in relapsed GD as it offers more rapid and lasting control of the hyperthyroidism, and for those with preexisting GO, it could also possibly reverse a certain degree of proptosis, eyelid width, and diplopia [7, 9–11]. In contrast to previous studies that evaluated the effect of thyroidectomy on GO, the aim of the present study was to evaluate whether GO, which remains a relative surgical indication, would affect surgical outcomes in GD.…”

Section: Discussionmentioning

confidence: 99%

Graves’ Ophthalmopathy as an Indication Increased the Risk of Hypoparathyroidism After Bilateral Thyroidectomy

Wong

Lang

2011

World j. surg.

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BackgroundStudies have evaluated the effect of thyroidectomy on the course of Graves’ ophthalmopathy (GO) but it is unclear how GO as an indication might affect surgical outcomes. We aimed to evaluate the impact of this indication on surgical outcomes in Graves’ disease (GD).MethodsFrom 1995 to 2008, 329 patients with GD underwent thyroidectomy. Patients were stratified into two groups, namely, those with GO as indication (GO) and those with non-GO indication (non-GO). Outcomes were compared between the groups and outcomes with significance were further analyzed by multivariate analyses to determine independent factors.ResultsThe GO group was significantly older (P < 0.001), had more males (P < 0.001), and fewer relapses (P < 0.001) than the non-GO group. It also had a higher proportion of total/near-total thyroidectomy (P < 0.001), despite a shorter operating time (P = 0.024) and less blood loss (P = 0.010). When only total/near-total thyroidectomy was considered, the GO group had significantly more permanent hypoparathyroidism than the non-GO group (9.2 vs. 1.6%, P = 0.038), but the rate of permanent hypoparathyroidism was similar in the two groups when only those with parathyroid autotransplantation were considered. Other complications were similar between the two groups. By multivariate analysis, GO as indication was an independent risk factor for temporary (OR 1.97, P = 0.033) and permanent hypoparathyroidism (OR 4.76, P = 0.007).ConclusionGO as a surgical indication (i.e., unstable or active GO requiring ophthalmic treatment or follow-up) was associated with increased risk of temporary and permanent hypoparathyroidism after bilateral thyroidectomy. Routine parathyroid autotransplantation may reduce the risk of permanent hypoparathyroidism in this select patient group.

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“…Elevation of serum levels of these antibodies after treatment with oral anti-thyroid drugs, radioactive iodine or surgical intervention seems to be an important prognostic factor of hyperthyroidism recurrence or progression of orbitopathy (14,15). On the other hand, decreased levels of these antibodies are associated with successive treatment.…”

Section: Discussionmentioning

confidence: 99%

“…It may be connected with various symptoms from only mild discomfort even up to serious damage, which may result in vision loss. Many studies comparing the results of radioactive iodine vs. surgical treatment on progressive orbitopathy showed that better long-term results were achieved following surgery (9,11,14).…”

Section: Discussionmentioning

confidence: 99%

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

Domosławski

Łukieńczuk

Forkasiewicz

et al. 2007

Polish Journal of Surgery

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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.

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The effect of subtotal thyroidectomy on Graves' ophthalmopathy

Cited by 15 publications

References 23 publications

Relationship Between Graves' Ophthalmopathy and Type of Treatment of Graves' Hyperthyroidism

Relationship Between Graves' Ophthalmopathy and Type of Treatment of Graves' Hyperthyroidism

Graves’ Ophthalmopathy as an Indication Increased the Risk of Hypoparathyroidism After Bilateral Thyroidectomy

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

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