title: Radioiodine ablation of postsurgical thyroid remnants after treatment with recombinant human TSH (rhTSH) in patients with moderate-to-severe graves' orbitopathy (GO): a prospective, randomized, single-blind clinical trial.
abstract: BACKGROUND
  Recent evidence suggests thyroidectomy (Tx) followed by radioiodine remnant ablation to be beneficial to Graves' orbitopathy (GO) patients.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the effect of (131)I thyroid ablation after recombinant human TSH stimulation in patients with moderate-to-severe GO.
  
  
  METHODS
  The study was prospective, randomized, and single-blind, and it included 40 consecutive patients with moderate-to-severe GO randomized into: 1) a Tx-radioactive iodine (RAI) group (20 subjects who underwent total-Tx and (131)I ablation after recombinant human TSH stimulation); and 2) a Tx group (20 subjects who underwent total-Tx alone).
  
  
  METHODS
  The overall GO outcome 12 months after Tx/radioiodine ablation was the main measure.
  
  
  RESULTS
  GO evaluation at the end of iv glucocorticoids showed eye disease to be improved in 65% of the Tx-RAI group and 60% of the Tx group patients. At 6 and 12 months, no further changes in the GO outcome could be observed in the Tx-RAI group. Conversely, five patients from the Tx group exhibited a deterioration in GO. At 12 months, GO was found to be improved in 70% of the Tx-RAI and 20% of the Tx group patients, the latter being found to be stable (55%) or worse (25%) than at baseline evaluation. At 12 months, GO was found to be inactive in a significantly higher percentage of patients in the Tx-RAI than in the Tx group (75 vs 30%; P < .01).
  
  
  CONCLUSIONS
  Postoperative radioiodine ablation proved more effective than Tx alone in inducing earlier and steadier GO improvement in patients with moderate-to-severe GO treated with iv glucocorticoids over a 24-month follow-up period.
authors.affiliation: Dipartimento di Medicina Clinica e Sperimentale, Sezione di Endocrinologia (M.M., M.A.V., B.D.B., G.S., S.P., F.T., F.V.); Dipartimento di Scienze Sperimentali Medico-Chirurgiche, Specialistiche ed Odontostomatologiche, Sezione di Oftalmologia (D.M., C.T.); Dipartimento di Scienze Economiche, Finanziarie, Sociali, Ambientali, Statistiche e del Territorio (A.A.); and Dipartimento di Scienze Radiologiche, Sezione di Medicina Nucleare (A.C., S.B.), University of Messina, 98122 Messina, Italy.
authors.forename: Mariacarla
authors.initials: M
authors.lastname: Moleti
authors.forename: Maria Antonia
authors.initials: MA
authors.lastname: Violi
authors.forename: Daniela
authors.initials: D
authors.lastname: Montanini
authors.forename: Costantino
authors.initials: C
authors.lastname: Trombetta
authors.forename: Beatrice
authors.initials: B
authors.lastname: Di Bella
authors.forename: Giacomo
authors.initials: G
authors.lastname: Sturniolo
authors.forename: Silvia
authors.initials: S
authors.lastname: Presti
authors.forename: Angela
authors.initials: A
authors.lastname: Alibrandi
authors.forename: Alfredo
authors.initials: A
authors.lastname: Campennì
authors.forename: Sergio
authors.initials: S
authors.lastname: Baldari
authors.forename: Francesco
authors.initials: F
authors.lastname: Trimarchi
authors.forename: Francesco
authors.initials: F
authors.lastname: Vermiglio
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D049970:Graves Ophthalmopathy / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use*; D016037:Single-Blind Method; D013961:Thyroid Gland / Q000187:drug effects / Q000601:surgery*; D013965:Thyroidectomy; D013972:Thyrotropin / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013972:Thyrotropin