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Cited by 69Ophthalmology and Eye DisordersThyroid Disorders and TreatmentsThyroid and Parathyroid Surgery

Time course of Graves’ ophthalmopathy after total thyroidectomy alone or followed by radioiodine therapy: a 2-year longitudinal study

De Bellis, Annamaria, Conzo, Giovanni, Cennamo, Gilda, Pane, Elena, Bellastella, Giuseppe, Colella, Caterina, Iacovo, Assunta Dello, Paglionico, Vanda Amoresano +4 more·2012·Endocrine
DOI 10.1007/s12020-011-9559-x
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Abstract

The findings in hyperthyroid patients with Graves' orbitopathy (GO) of antibodies against antigens shared between the thyroid and orbit, such as the TSH-receptor (TRAb) and a novel protein G2s (G2sAb), suggested a possible common therapeutic strategy. However, the gold therapeutic standard for hyperthyrodism in these patients remains still unsettled and is mainly based on personal experience. Studies on the effect of total thyroidectomy (TT) alone or followed by radioiodine ablation (RAI) of thyroid remnants showed often conflicting results. This longitudinal study was aimed at evaluating the influence of TT alone or followed by post-surgical RAI with respect to methimazole treatment on the activity and severity of GO in patients with hyperthyroidism and GO. Sixty consecutive patients with Graves' disease and mild/moderate GO were studied and grouped as follows: group 1, including 25 patients (16F, 9M) undergoing TT alone; group 2, including 10 patients (8F, 2M) undergoing TT followed by RAI for histological evidence of differentiated thyroid cancer; group 3, including 25 patients (18F, 7M) euthyroid under methimazole therapy, studied as controls. Clinical study of ophthalmopathy and measurements of TRAb and G2sAb were performed in all patients at start of the study (time of TT for group 1 and RAI after TT for group 2 and of the first finding of euthyroidism under methimazole treatment for group 3) and after 6, 12, 24 months. Patients of both groups 1 and 2 showed an early significant decrease and a further progressive reduction of the activity and severity of GO with a disappearance of TRAb and a decrease of G2sAb levels during the follow-up, without statistically significant differences between the two groups. Patients in group 3 showed a much later and less marked improvement of GO with persistence of TRAb and G2sAb positivity, even if with reduction of TRAb levels at 12 and 24 months. Our results suggest that in Graves' patients with large goiter or relapse of hyperthyroidism and mild/moderate GO, TT alone could be an advisable choice to treat hyperthyroidism also improving GO with reduction of cost/benefit ratio.

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Authors
De Bellis, A., Conzo, G., Cennamo, G., Pane, E., Bellastella, G., Colella, C., Iacovo, A. D., Paglionico, V. A., Sinisi, A. A., Wall, J. R., Bizzarro, A., & Bellastella, A.
Affiliations
  • University of Campania "Luigi Vanvitelli" (IT)
  • Federico II University Hospital (IT)
  • The University of Sydney (AU)
Corresponding author
Bellastella, Antonio
ORCID
Venue
Endocrine
Publisher
Springer Science and Business Media LLC
Published
2011-11-16
Volume
41
Issue
2
Pages
320-326
ISSN
  • 0969-711X (ISSN-L)
  • 1355-008X
  • 1559-0100
DOI
10.1007/s12020-011-9559-x
OpenAlex
W2086954092
Cited by
69
References
33
Citations by year
2026: 1 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 4 · 2017: 4 · 2016: 10 · 2015: 8 · 2014: 11 · 2013: 12 · 2012: 4
FWCI
6.08
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Endocrine (publishedVersion)
  • PubMed (publishedVersion)
  • Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Keywords
Graves' ophthalmopathy, Graves' disease, total thyroidectomy, radioiodine ablation, hyperthyroidism, TSH receptor antibodies, methimazole, goiter
MeSH terms
Adult, Antineoplastic Agents, Autoantibodies, Combined Modality Therapy, Diplopia, Exophthalmos, Eye Proteins, Female, Goiter, Humans, Hyperthyroidism, Iodine Radioisotopes, Longitudinal Studies, Male, Membrane Proteins, Receptors, Thyrotropin, Severity of Illness Index, Antithyroid Agents, Thyroid Neoplasms, Thyroidectomy, Radiopharmaceuticals, Graves Ophthalmopathy, Secondary Prevention

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