Abstract

SO.08.06

The effect of early thyroidectomy on the course of Graves` Orbitopathy (GO)

Melissa Thanos1, Kristian T. M. Johnson1, Martin K. Walz2, Klaus Mann3, Klaus-Peter Steuhl1, Joachim Esser1, Anja K. Eckstein1
1Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen, 2Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, 3Klinik für Endokrinologie, Zentrum für Innere Medizin, Universitätsklinikum Essen, Essen

Objective
To investigate the effect of early thyroidectomy versus conventional antithyroid drug treatment (ATD) on the course of Graves` orbitopathy (GO).
Methods
Two GO patient cohorts were retrospectively evaluated. The patients either received an early thyroidectomy (Tx group) 6-months after the beginning of antithyroid drug (ATD) therapy or this therapy was continued for another 6 months (ATD group). Patients who stayed in remission 12 – 30 months after cessation of ATD were excluded. GO was evaluated (activity, severity, TSH-receptor-antibodies = TRAb, inactivation rate, antiinflammatory therapy) at baseline and after 6-months follow-up.
Results
At baseline severity of GO was similar in both groups (median NOSPECS score 6 (Tx) versus 7 (ATD)[p=0.72]. GO was significantly more active (median CAS=6) in the early Tx group in comparison to the ATD group (median CAS=4)[0.02]. Median TRAb were higher in the Tx group (median 19.5 IU/l) than in the ATD group (median 9.3 IU/l)[p=0.06]. There were no differences concerning age, sex, smoking behaviour prior antiinflammatory therapy. After 6 months of follow up, patients of both groups had received equal amounts of steroid and radiotherapy. 100% of the patients had received steroids and 75%/72% orbital radiotherapy. Severity scores decreased in comparable amounts in both groups to 5 in the Tx group and to 6 in the ATD therapy group. However, GO was inactivated in 87.5% of the patients after early thyroidectomy in comparison to only 66.7% during further ATD therapy [p=0.1].
Conclusions
Residual GO symptoms are not different 6 months after early thyroidectomy in comparison to patients who received further ATD therapy. However the rate of inactivation of GO is higher after early thyroidectomy (although more active at baseline). This allows an earlier beginning of rehabilitative surgery for patients with early thyroidectomy, which may influence the quality of life.

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