Effects of Total Thyroid Ablation Versus Near-Total Thyroidectomy Alone on Mild to Moderate Graves’ Orbitopathy Treated with Intravenous Glucocorticoids

• Published in: The journal of clinical endocrinology and metabolism 2007-05, Vol.92 (5), p.1653-1658
• Main Authors: Menconi, Francesca, Marinò, Michele, Pinchera, Aldo, Rocchi, Roberto, Mazzi, Barbara, Nardi, Marco, Bartalena, Luigi, Marcocci, Claudio
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Combined Modality Therapy; Endocrinopathies; Female; Fundamental and applied biological sciences. Psychology; Glucocorticoids - administration & dosage; Glucocorticoids - therapeutic use; Graves Ophthalmopathy - surgery; Graves Ophthalmopathy - therapy; Humans; Injections, Intravenous; Iodine Radioisotopes - therapeutic use; Linear Models; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Patient Dropouts; Prospective Studies; Single-Blind Method; Thyroid Gland - surgery; Thyroid Hormones - blood; Thyroid. Thyroid axis (diseases); Thyroidectomy; Treatment Outcome; Vertebrates: endocrinology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2006-1800

Context: Graves’ orbitopathy (GO) is probably caused by autoimmune reactions against autoantigen(s) shared by thyroid and orbital tissues sustained by intrathyroidal autoreactive T-lymphocytes infiltrating the orbit. Total thyroid ablation (TTA) may be beneficial for GO through removal of shared antigen(s) and autoreactive T-lymphocytes, but randomized studies are lacking. Objective: Our objective was to evaluate the effects of TTA in patients with GO treated with iv glucocorticoids (GC). Design/Setting: A prospective, single-blind, randomized study was conducted at a referral center. Patients/Interventions: Sixty patients with mild to moderate GO were randomized into: 1) near-total thyroidectomy (TX); or 2) TX plus 131I (TTA) groups, and then treated with iv GC. Patients were evaluated 3 and 9 months after iv GC. Main Outcome Measure: Overall improvement of GO at 9 months was the main outcome measure. Results: The distribution of GO outcome at 9 months was significantly more favorable in TTA than in TX patients (P = 0.0014 by χ2 test). A cumulative significant (P = 0.0054) difference between the two groups at 3 and 9 months was found using a generalized linear model. Radioiodine uptake test and thyroglobulin assay in a patient sample showed complete ablation in the majority of TTA, but not of TX patients. Conclusions: Compared with thyroidectomy alone, TTA is followed by a better outcome of GO in patients given iv GC. Whether TTA maintains this advantage in the long-term remains to be established.