Document Detail

Graves' disease with moderate-severe endocrine ophthalmopathy-long term results of a prospective, randomized study of total or subtotal thyroid resection.
MedLine Citation:
PMID:  16279849     Owner:  NLM     Status:  MEDLINE    
The optimal thyroid surgery to be performed in patients with Graves' disease and concomitant endocrine ophthalmopathy is a matter of debate. We randomly assigned 44 patients with moderate-severe eye signs in a trial of treatment with subtotal, leaving a small (approximately 2 g) thyroid remnant, or total thyroidectomy. At inclusion, the patients had been treated with antithyroid drugs, and corticosteroids been given to 12 (27%). All received postoperative thyroxine supplementation and were followed for 3 years at regular examinations. The eye disease improved in all cases, and throughout the study, the two groups did not differ with regard to subjective and objective eye symptoms and laboratory findings. At the study start, motility disturbances were present in 8 and 11 of the cases in the subtotal and total resection group and proptosis in 16 and 17, respectively. After 3 years, the corresponding data were 3 and 6 cases with motility defects and 16 and 15 cases with proptosis. Thyrotropin (TSH)-receptor antibody levels gradually fell and became nondetectable in 21 (49%). The surgical complication rate (permanent recurrent laryngeal nerve paresis and permanent hypoparathyroidism) was significantly higher in the total thyroidectomy group. The data indicate that in patients with Graves' disease and active endocrine ophthalmopathy, subtotal thyroidectomy, leaving a small thyroid remnant, will reduce the risk of surgical complications but not the beneficial effect of surgery.
J Järhult; C Rudberg; E Larsson; H Selvander; K Sjövall; B Winsa; J Rastad; F A Karlsson;
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  15     ISSN:  1050-7256     ISO Abbreviation:  Thyroid     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-11-10     Completed Date:  2006-03-10     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1157-64     Citation Subset:  IM    
Department of Surgery, Eksjö Hospital, Sweden.
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MeSH Terms
Follow-Up Studies
Graves Ophthalmopathy / surgery*
Middle Aged
Ocular Motility Disorders / etiology
Receptors, Thyrotropin / immunology
Thyroidectomy* / adverse effects,  methods
Reg. No./Substance:
0/Receptors, Thyrotropin

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