Destruction
of the thyroid gland can ameliorate eye problems in patients with
Graves' disease
(November 2003)
The background of the study. Eye
problems, commonly referred to as ophthalmopathy, are an important
manifestation of Graves' disease, although not as common as hyperthyroidism.
The occurrence of ophthalmopathy may depend on the presence of thyroid
tissue. This study evaluated the effect of thyroidectomy and radioiodine-induced
thyroid destruction in patients with Graves' ophthalmopathy.
How the study was done. The study
subjects were 55 patients with hyperthyroidism caused by Graves'
disease and mild or moderate ophthalmopathy, as defined by mild-to-moderate
eye changes (swelling around the eyes, double vision, protrusion
of the eyes [exophthalmos]). All underwent thyroidectomy, and 16
were later treated with radioiodine to destroy any remaining thyroid
tissue. All were then treated with thyroxine. The patients were
divided into those with active ophthalmopathy and those with inactive
ophthalmopathy, on the basis of a Clinical Activity Score determined
at the time of surgery and 6, 12, and 24 months after surgery.
The results of the study. At the
time of surgery, 31 patients had active eye disease and 24 had inactive
eye disease. In the patients with active eye disease, the activity
decreased substantially, so that at 6 months 61 percent had inactive
eye disease, and at 24 months 71 percent had inactive eye disease.
In 38 percent of the patients with inactive eye disease, the disease
became active during the 24-month follow-up period.
Among the 39 patients treated with thyroidectomy alone, the eye
disease was still active at 24 months in 46 percent. Among the 16
patients treated with surgery and radioiodine, no patient had active
eye disease at 24 months.
The conclusions of the study. In
patients with Graves' ophthalmopathy, complete thyroid destruction
(thyroidectomy and radioiodine therapy) is more effective than thyroidectomy
alone in decreasing the activity of the eye disease.
The original article. Moleti M,
Mattina F, Salamone I, Violi MA, Nucera C, Baldari S, Lo Schiavo
MG, Regalbuto C, Trimarchi F, Vermiglio F. Effects of thyroidectomy
alone or followed by radioiodine ablation of thyroid remnants on
the outcome of Graves' ophthalmopathy. Thyroid 2003;13:653-8
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