The course of Graves' ophthalmopathy is not influenced by near total thyroidectomy: a case-control study.
OBJECTIVE
The relationship between the method of treatment of hyperthyroidism due to Graves' disease and the course of Graves' ophthalmopathy is debated. Antithyroid drug therapy is associated with no change, or even amelioration, of ophthalmopathy. Although controversial, radioiodine may be followed by progression of eye disease, preventable by glucocorticoid administration. Whether thyroidectomy affects the course of ophthalmopathy is uncertain.


METHODS
In a case control study, the course of non-severe Graves' ophthalmopathy after thyroidectomy was investigated and the results compared with those observed in patients treated with methimazole.


METHODS
Thirty patients with Graves' hyperthyroidism and non-severe/absent ophthalmopathy were treated with near-total thyroidectomy (Group 1, Tx), after achievement of euthyroidism with methimazole. After surgery, all patients started levothyroxine replacement therapy. Sixty patients treated with methimazole, matched for age, sex, duration of hyperthyroidism, degree of ocular involvement and smoking habits, were used as controls (Group 2, MMI).


METHODS
Patients were seen every 1-2 months for 12 months for thyroid tests and ocular evaluation.


RESULTS
In Group 1, ocular parameters did not change in 17 of 18 patients with pre-existing ophthalmopathy, and in 12 patients without ophthalmopathy. Eye manifestations worsened only in one (3.3%) patient with pre-existing ophthalmopathy. In Group 2, ocular parameters did not change in 58 patients (33 with, and 25 without ophthalmopathy), while new ophthalmopathy occurred in two without pre-existing eye disease. One of the 30 patients treated by surgery (3.3%) had permanent hypoparathyroidism.


CONCLUSIONS
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.
Marcocci
C
C
Dipartimento di Endocrinologia e Metabolismo, Ortopedia e Traumatologia, Medicina del Lavoro, Pisa, Italy. c.marcocci@endoc.med.unipi.it
Bruno-Bossio
G
G
Manetti
L
L
Tanda
M L
ML
Miccoli
P
P
Iacconi
P
P
Bartolomei
M P
MP
Nardi
M
M
Pinchera
A
A
Bartalena
L
L
D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005094:Exophthalmos / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006111:Graves Disease / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008713:Methimazole / Q000627:therapeutic use; D018709:Statistics, Nonparametric; D013965:Thyroidectomy; D017211:Treatment Failure; D014792:Visual Acuity
D013956:Antithyroid Agents; D008713:Methimazole