title: Comparison of Early Total Thyroidectomy with Antithyroid Treatment in Patients with Moderate-Severe Graves' Orbitopathy: A Randomized Prospective Trial.
abstract: BACKGROUND
  The optimal therapeutic choice for Graves' hyperthyroidism in the presence of moderate-severe Graves' orbitopathy (GO) remains controversial.
  
  
  OBJECTIVE
  We aimed to compare GO course in patients with moderate-severe GO treated with early total thyroidectomy (TTx) versus antithyroid drug (ATD) regimens, in a prospective, randomized manner.
  
  
  METHODS
  Forty-two patients with moderate-severe GO were enrolled. A total of 4.5 g of pulse corticosteroids were given intravenously to all patients before randomization. Patients in the first group were given TTx, whereas patients in the second group were treated with ATDs. TSH was kept between 0.4 and 1 mIU/l. The clinical course of GO was evaluated with proptosis, lid aperture, clinical activity score (CAS), and diplopia.
  
  
  RESULTS
  Eighteen and 24 patients were randomized to the TTx and ATD groups, respectively. Thyroid autoantibodies decreased significantly, and there were significant improvements in proptosis, lid aperture, and CAS in the TTx group. While in the ATD group the decrement in thyroid autoantibodies was not significant, there were significant improvements in proptosis and CAS. When the TTx group was compared with the ATD group, anti-TPO, anti-Tg, and TSH-receptor antibodies were significantly decreased in the TTx group (p < 0.01), but there was no significant difference with respect to proptosis, lid aperture, CAS, and diplopia between the two groups during a median (min.-max.) follow-up period of 60 months (36-72).
  
  
  CONCLUSIONS
  Although no definitive conclusions could be drawn from the study, mainly due to limited power, early TTx and the ATD treatment regimens, followed by intravenous pulse corticosteroid therapy, seemed to be equally effective on the course of GO in this relatively small group of patients with moderate-severe GO during a median (min.-max.) follow-up period of 60 months (36-72).
authors: Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey.
authors: Murat Faik
authors: MF
authors: Erdoğan
authors: Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey.
authors: Özgür
authors: Ö
authors: Demir
authors: Department of Endocrinology and Metabolic Diseases, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey.
authors: Reyhan Ünlü
authors: RÜ
authors: Ersoy
authors: Department of Endocrinology and Metabolic Diseases, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey.
authors: Kamile
authors: K
authors: Gül
authors: Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey.
authors: Berna İmge
authors: Bİ
authors: Aydoğan
authors: Department of Endocrinology and Metabolic Diseases, Ankara Training and Research Hospital, Ankara, Turkey.
authors: Ziynet Alphan
authors: ZA
authors: Üç
authors: Endocrinology and Metabolic Diseases, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors: Türkan
authors: T
authors: Mete
authors: Department of Endocrinology and Metabolic Diseases, Ufuk University Medical Faculty, Ankara, Turkey.
authors: Sibel
authors: S
authors: Ertek
authors: Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey.
authors: Uğur
authors: U
authors: Ünlütürk
authors: Department of Endocrinology and Metabolic Diseases, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey.
authors: Bekir
authors: B
authors: Çakır
authors: Department of Endocrinology and Metabolic Diseases, Ankara Training and Research Hospital, Ankara, Turkey.
authors: Yalçın
authors: Y
authors: Aral
authors: Endocrinology and Metabolic Diseases, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors: Serdar
authors: S
authors: Güler
authors: Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey.
authors: Sevim
authors: S
authors: Güllü
authors: Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey.
authors: Demet
authors: D
authors: Çorapçıoğlu
authors: Department of Endocrinology and Metabolic Diseases, Hacettepe University Medical Faculty, Ankara, Turkey.
authors: Selçuk
authors: S
authors: Dağdelen
authors: Department of Endocrinology and Metabolic Diseases, Ufuk University Medical Faculty, Ankara, Turkey.
authors: Gürbüz
authors: G
authors: Erdoğan
keywords: Antithyroid treatment; Graves’ orbitopathy; Total thyroidectomy