title: Effects of total thyroid ablation versus near-total thyroidectomy alone on mild to moderate Graves' orbitopathy treated with intravenous glucocorticoids.
abstract: BACKGROUND
  Graves' orbitopathy (GO) is probably caused by autoimmune reactions against autoantigen(s) shared by thyroid and orbital tissues sustained by intrathyroidal autoreactive T-lymphocytes infiltrating the orbit. Total thyroid ablation (TTA) may be beneficial for GO through removal of shared antigen(s) and autoreactive T-lymphocytes, but randomized studies are lacking.
  
  
  OBJECTIVE
  Our objective was to evaluate the effects of TTA in patients with GO treated with iv glucocorticoids (GC).
  
  
  METHODS
  A prospective, single-blind, randomized study was conducted at a referral center.
  
  
  METHODS
  Sixty patients with mild to moderate GO were randomized into: 1) near-total thyroidectomy (TX); or 2) TX plus (131)I (TTA) groups, and then treated with iv GC. Patients were evaluated 3 and 9 months after iv GC.
  
  
  METHODS
  Overall improvement of GO at 9 months was the main outcome measure.
  
  
  RESULTS
  The distribution of GO outcome at 9 months was significantly more favorable in TTA than in TX patients (P = 0.0014 by chi(2) test). A cumulative significant (P = 0.0054) difference between the two groups at 3 and 9 months was found using a generalized linear model. Radioiodine uptake test and thyroglobulin assay in a patient sample showed complete ablation in the majority of TTA, but not of TX patients.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Endocrinology, University of Pisa, Via Paradisa 2, 56100 Pisa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Menconi
authors.forename: Michele
authors.initials: M
authors.lastname: Marinò
authors.forename: Aldo
authors.initials: A
authors.lastname: Pinchera
authors.forename: Roberto
authors.initials: R
authors.lastname: Rocchi
authors.forename: Barbara
authors.initials: B
authors.lastname: Mazzi
authors.forename: Marco
authors.initials: M
authors.lastname: Nardi
authors.forename: Luigi
authors.initials: L
authors.lastname: Bartalena
authors.forename: Claudio
authors.initials: C
authors.lastname: Marcocci
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D049970:Graves Ophthalmopathy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007275:Injections, Intravenous; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D011446:Prospective Studies; D016037:Single-Blind Method; D013961:Thyroid Gland / Q000601:surgery*; D013963:Thyroid Hormones / Q000097:blood; D013965:Thyroidectomy; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007457:Iodine Radioisotopes; D013963:Thyroid Hormones