title: The Effect of Early Thyroidectomy on the Course of Active Graves' Orbitopathy (GO): A Retrospective Case Study.
abstract: The aim of the work was to investigate the effect of early thyroidectomy on the course of active Graves' orbitopathy (GO) in patients with low probability of remission [high TSH receptor antibody (TRAb) serum levels, severe GO] compared to that of continued therapy with antithyroid drugs. Two cohorts were evaluated retrospectively (total n=92 patients with active GO, CAS≥4). Forty-six patients underwent early thyroidectomy (Tx-group) 6±2 months after initiation of antithyroid drug (ATD) therapy, while ATD was continued for another 6±2 months in the ATD-group (n=46). These controls were consecutively chosen from a database and matched to the Tx-group. GO was evaluated (activity, severity, TRAb) at baseline and at 6 month follow-up. At baseline, both cohorts were virtually identical as to disease severity, activity and duration, as well as prior anti-inflammatory treatment, age, gender, and smoking behavior. At 6 month follow-up, NOSPECS severity score was significantly decreased within each group, but did not differ between both groups. However, significantly more patients of the Tx-group presented with inactive GO (89.1 vs. 67.4%, * p=0.02), and mean CAS score was significantly lower in Tx-group (2.1) than in ADT-group (2.8; * p=0.02) at the end of follow-up. TRAb levels declined in both groups (Tx-group: from 18.6 to 5.2 vs. ATD-group: 12.8-3.2 IU/l, p0=0.07, p6months=0.32). Residual GO activity was lower in Tx-group, associated with a higher rate of inactivation of GO. This allows an earlier initiation of ophthalmosurgical rehabilitation in patients with severe GO, which may positively influence quality of life of the patients.
authors.affiliation: Center for Ophthalmology, Department of Neuroophthalmology and Strabismus, University of Duisburg-Essen, Essen, Germany.|Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Meyer Zu Horste
authors.affiliation: Center for Ophthalmology, Department of Neuroophthalmology and Strabismus, University of Duisburg-Essen, Essen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Pateronis
authors.affiliation: Department of Surgery and Center for Minimal Invasive Surgery, Huyssen-Stift Essen, Essen, Germany.
authors.forename: M K
authors.initials: MK
authors.lastname: Walz
authors.affiliation: Department of Surgery and Center for Minimal Invasive Surgery, Huyssen-Stift Essen, Essen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Alesina
authors.affiliation: Center for Internal Medicine, Department of Endocrinology, University of Essen, Essen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Mann
authors.affiliation: Center for Internal Medicine, Department of Endocrinology, Diabetology and Rheumatology, University Duesseldorf, Duesseldorf, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schott
authors.affiliation: Center for Ophthalmology, Department of Neuroophthalmology and Strabismus, University of Duisburg-Essen, Essen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Esser
authors.affiliation: Center for Ophthalmology, Department of Neuroophthalmology and Strabismus, University of Duisburg-Essen, Essen, Germany.
authors.forename: A K
authors.initials: AK
authors.lastname: Eckstein
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D049970:Graves Ophthalmopathy / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013965:Thyroidectomy
chemical_list: D000893:Anti-Inflammatory Agents