The Effect of Early Thyroidectomy on the Course of Active Graves’ Orbitopathy (GO): A Retrospective Case Study

• Published in: Hormone and metabolic research Vol. 48; no. 7; pp. 433 - 439
• Main Authors: Meyer zu Horste, M., Pateronis, K., Walz, M. K., Alesina, P., Mann, K., Schott, M., Esser, J., Eckstein, A. K.
• Format: Journal Article
• Language: English
• Published: Stuttgart · New York Georg Thieme Verlag KG 01.07.2016
• Subjects: Anti-Inflammatory Agents - therapeutic use; Disease Progression; Endocrine Care; Female; Follow-Up Studies; Graves Ophthalmopathy - drug therapy; Graves Ophthalmopathy - pathology; Graves Ophthalmopathy - surgery; Humans; Male; Middle Aged; Retrospective Studies; Thyroidectomy; thyroid treatment; ATD; thyroidectomy; course of GO
• ISSN: 0018-5043; 1439-4286
• DOI: 10.1055/s-0042-108855

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, p 0 =0.07, p 6months =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.