title: Total thyroidectomy for the treatment of recurrent graves' disease with ophthalmopathy.
abstract: OBJECTIVE
  To determine the outcome of recurrent Graves' disease with ophthalmopathy (GO) following bilateral total thyroidectomy (TT) in patients with no history of anti-inflammatory treatment with steroids or radioactive iodine treatment.
  
  
  METHODS
  From May 2002 to August 2005, 35 patients (27 female, 8 male) with different stages of Graves' disease underwent TT. The degree of ophthalmopathy was assessed by the NOSPECS scoring system and thyrotropin receptor antibody (TRAb) levels were measured for the detection of thyroidal and retro-orbital inflammatory activity before and after surgery.
  
  
  RESULTS
  The mean duration of thyroid disease was 21.4 months and mean follow-up was 422 days. Significant improvement, which was defined as complete regression of periorbital oedema accompanied by a > 1 point decrease in NOSPECS, was observed in 30 (85%) patients. The remaining five patients had stable eye disease. The mean TRAb value and NOSPECS score before and after TT were 33.8 U/L versus 3.4 U/L and 3.0 versus 1.52, respectively, and the differences were statistically significant (p < 0.0000). A major reduction in TRAb values achieved after TT was clearly indicative of undetectable inflammatory activity and all the patients demonstrated negative TRAb values within 6 months of the operation. TT was accomplished with very low morbidity (3%) and provided a significant reduction in TRAb levels with attendant improvement in GO in the vast majority of patients in this study.
  
  
  CONCLUSIONS
  TT resulted in a significant reduction in TRAb levels with concomitant regression of recurrent GO in all patients. The operative morbidity was very low and mortality was nil. However, the long-term consequences of permanent hypothyroidism, which is the ultimate result of TT, are of major concern.
authors.affiliation: Department of General Surgery and Organ Transplantation, and Research Center, Izmir Teaching Hospital, Ministry of Health, Izmir, Turkey. ahmetnart@yahoo.com
authors.forename: Ahmet
authors.initials: A
authors.lastname: Nart
authors.forename: Adam
authors.initials: A
authors.lastname: Uslu
authors.forename: Ahmet
authors.initials: A
authors.lastname: Aykas
authors.forename: Fatih
authors.initials: F
authors.lastname: Yuzbasioglu
authors.forename: Murat
authors.initials: M
authors.lastname: Dogan
authors.forename: Ozgur
authors.initials: O
authors.lastname: Demirtas
authors.forename: Cenk
authors.initials: C
authors.lastname: Simsek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D049970:Graves Ophthalmopathy / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011989:Receptors, Thyrotropin / Q000276:immunology; D012008:Recurrence; D013965:Thyroidectomy; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D011989:Receptors, Thyrotropin