The course of Graves' ophthalmopathy is not influenced by near total thyroidectomy: a case-control study

OBJECTIVE The relationship between the method of treatment of hyperthyroidi sm due to Graves' disease and the course of Graves' ophthalmopathy is debat ed. Antithyroid drug therapy is associated with no change, or even ameliora tion, of ophthalmopathy. Although controversial, radioiodine may be followe d by progression of eye disease, preventable by glucocorticoid administrati on. Whether thyroidectomy affects the course of ophthalmopathy is uncertain , DESIGN In a case control study, the course of non-severe Graves' ophthalmop athy after thyroidectomy was investigated and the results compared with tho se observed in patients treated with methimazole, PATIENTS Thirty patients with Graves' hyperthyroidism and non-severe/absent ophthalmopathy were treated with near-total thyroidectomy (Group 1, Tx), a fter achievement of euthyroidism with methimazole. After surgery, all patie nts started levothyroxine replacement therapy. Sixty patients treated with methimazole, matched for age, sex, duration of hyperthyroidism, degree of o cular involvement and smoking habits, were used as controls (Group 2, MMI), MEASUREMENTS Patients were seen every 1-2 months for 12 months for thyroid tests and ocular evaluation. RESULTS In Group 1, ocular parameters did not change in 17 of 18 patients w ith pre-existing ophthalmopathy, and in 12 patients without ophthalmopathy, Eye manifestations worsened only in one (3.3%) patient with pre-existing o phthalmopathy. In Group 2, ocular parameters did not change in 58 patients (33 with, and 25 without ophthalmopathy), while new ophthalmopathy occurred in two without pre-existing eye disease, One of the 30 patients treated by surgery (3.3%) had permanent hypoparathyroidism. CONCLUSIONS Treatment of Graves' hyperthyroidism with near-total thyroidect omy in patients with non-severe or absent pre-existing ophthalmopathy is no t associated in the short term with significant effects on the course of op hthalmopathy.