title: Time course of Graves' ophthalmopathy after total thyroidectomy alone or followed by radioiodine therapy: a 2-year longitudinal study.
abstract: The findings in hyperthyroid patients with Graves' orbitopathy (GO) of antibodies against antigens shared between the thyroid and orbit, such as the TSH-receptor (TRAb) and a novel protein G2s (G2sAb), suggested a possible common therapeutic strategy. However, the gold therapeutic standard for hyperthyrodism in these patients remains still unsettled and is mainly based on personal experience. Studies on the effect of total thyroidectomy (TT) alone or followed by radioiodine ablation (RAI) of thyroid remnants showed often conflicting results. This longitudinal study was aimed at evaluating the influence of TT alone or followed by post-surgical RAI with respect to methimazole treatment on the activity and severity of GO in patients with hyperthyroidism and GO. Sixty consecutive patients with Graves' disease and mild/moderate GO were studied and grouped as follows: group 1, including 25 patients (16F, 9M) undergoing TT alone; group 2, including 10 patients (8F, 2M) undergoing TT followed by RAI for  histological evidence of differentiated thyroid cancer; group 3, including 25 patients (18F, 7M) euthyroid under methimazole therapy, studied as controls. Clinical study of ophthalmopathy and measurements of TRAb and G2sAb were performed in all patients at start of the study (time of TT for group 1 and RAI after TT for group 2 and of the first finding of euthyroidism under methimazole treatment for group 3) and after 6, 12, 24 months. Patients of both groups 1 and 2 showed an early significant decrease and a further progressive reduction of the activity and severity of GO with a disappearance of TRAb and a decrease of G2sAb levels during the follow-up, without statistically significant differences between the two groups. Patients in group 3 showed a much later and less marked improvement of GO with persistence of TRAb and G2sAb positivity, even if with reduction of TRAb levels at 12 and 24 months. Our results suggest that in Graves' patients with large goiter or relapse of hyperthyroidism and  mild/moderate GO, TT alone could be an advisable choice to treat hyperthyroidism also improving GO with reduction of cost/benefit ratio.
authors.affiliation: Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Via Pansini N. 5, 80131 Naples, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: De Bellis
authors.forename: Giovanni
authors.initials: G
authors.lastname: Conzo
authors.forename: Gilda
authors.initials: G
authors.lastname: Cennamo
authors.forename: Elena
authors.initials: E
authors.lastname: Pane
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellastella
authors.forename: Caterina
authors.initials: C
authors.lastname: Colella
authors.forename: Assunta Dello
authors.initials: AD
authors.lastname: Iacovo
authors.forename: Vanda Amoresano
authors.initials: VA
authors.lastname: Paglionico
authors.forename: Antonio Agostino
authors.initials: AA
authors.lastname: Sinisi
authors.forename: Jack R
authors.initials: JR
authors.lastname: Wall
authors.forename: Antonio
authors.initials: A
authors.lastname: Bizzarro
authors.forename: Antonio
authors.initials: A
authors.lastname: Bellastella
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D013956:Antithyroid Agents / Q000627:therapeutic use*; D001323:Autoantibodies / Q000032:analysis; D003131:Combined Modality Therapy; D004172:Diplopia / Q000209:etiology / Q000517:prevention & control; D005094:Exophthalmos / Q000209:etiology / Q000517:prevention & control; D005136:Eye Proteins / Q000037:antagonists & inhibitors; D005260:Female; D006042:Goiter / Q000209:etiology; D049970:Graves Ophthalmopathy / Q000276:immunology / Q000503:physiopathology / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology / Q000517:prevention & control; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008565:Membrane Proteins / Q000037:antagonists & inhibitors; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D011989:Receptors, Thyrotropin / Q000037:antagonists & inhibitors; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013964:Thyroid Neoplasms / Q000150:complications / Q000473:pathology / Q000532:radiotherapy; D013965:Thyroidectomy
chemical_list: D000970:Antineoplastic Agents; D013956:Antithyroid Agents; D001323:Autoantibodies; D005136:Eye Proteins; C406963:G2s protein, human; D007457:Iodine Radioisotopes; D008565:Membrane Proteins; D019275:Radiopharmaceuticals; D011989:Receptors, Thyrotropin