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The effect of subtotal thyroidectomy on Graves' ophthalmopathy

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Abstract

Nineteen unselected patients undergoing subtotal thyroidectomy (STT) for Graves' disease were submitted to thorough ophthalmologic assessment before and after (mean, 10 mo) thyroid surgery. All clinical examinations were performed by the same observer and findings were scored according to the American Thyroid Association (“NOSPECS”) classification. Orbital computed tomography (CT) scans were performed in all patients prior to surgery and again at follow-up if the initial scan was abnormal or if there was evidence of clinical deterioration; all CT scans were viewed by the same individual. There was evidence of infiltrative ophthalmopathy at some stage in the course of observation in 17 (89%) of the 19 patients.

No predictable ocular response to STT was apparent. Ophthalmic status was noted to improve in 6 patients, to remain unchanged in 7 patients, and to progressively deteriorate in 6 patients. This unpredictable pattern was seen irrespective of the severity of preexisting ocular involvement. The absence of any consistent or predictable ocular response to STT strongly suggests that thyroidectomy does not influence the natural course of Graves' ophthalmopathy. We believe that the presence of evolving or stable ophthalmopathy, even if severe, should not be regarded as a contraindication to STT in Graves' disease.

Résumé

Dix-neuf patients non sélectionnés ont eu une évaluation ophthalmologique avant et après (moyenne, 10 mois) une thyroïdectomie subtotale (TST) pour maladie de Basedow. Tous les examens ont été faits par le même médecin, et les résultats ont été notés selon la classification “NOSPECS” de l'American Thyroid Association. Une tomodensitométrie (TDM) orbitale a été effectuée chez tous les patients avant la thyroïdectomie et une fois encore après si l'examen initial était anormal, ou si l'état clinique s'aggravait. Tous les résultats de TDM orbitale ont été interprétés par le même médecin. Dix-sept (89%) des 19 patients avaient une ophtalmopathie infiltrative à un moment donné de l'évolution.

On n'a pas mis en évidence de réponse oculaire à la TST. L'état ophtalmique s'est amélioré chez 6 patients, est resté inchangé chez 7, et s'est détérioré chez les 6 autres. L'évolution ophtalmique était imprévisible quelle que soit la sévérité de l'état ophtalmique préexistant. L'absence de réponse oculaire constante ou prévisible dans cette série suggère fortement que la thyroïdectomie n'influe pas sur l'évolution naturelle de l'ophtalmopathie de la maladie de Basedow. Nous croyons que la présence d'ophtalmopathie, stable ou pas, même si elle est sévère, ne devrait pas constituer une contre-indication à la TST dans la maladie de Basedow.

Resumen

Diecinueve patientes no seleccionados sometidos a tiroidectomía subtotal (TST) por enfermedad de Graves fueron llevados a una completa valoración oftalmológica antes y después (promedio, 10 meses) de la cirugía tiroidea. Todos los exámenes clínicos fueron realizados por el mismo observador y los hallazgos fueron registrados de acuerdo con la clasificación de la Asociación Americana de Tiroides (“NOSPECS”). Se hicieron tomografías computadorizadas (TC) orbitales en todos los pacientes antes de la cirugía y en el período de seguimiento si la escanografía inicial era anormal o si había evidencia de deterioro clínico; todas las TC fueron interpretadas por la misma persona. Se halló evidencia de oftalmopatía infiltrativa en algún momento en el curso de la observación en 17 (89%) de los 19 pacientes.

Ninguna respuesta ocular predecible a la TST se hizo aparente. El estado oftálmico mejoró en 6 pacientes, permaneció sin cambio en 7, y se deterioró en forma progresiva en 6. Este impredecible patrón fue observado con independencia de la gravedad de la afección ocular preexistente. La ausencia de una respuesta ocular predecible o consistente a la TST ciertamente sugiere que la tiroidectomía no influencia la evolutión natural de la oftalmopatía de Graves. Creemos que la presencia de una oftalmopatía estable o en evolución, aún si es severa, no debe ser considerada como contraindicatión para la TST en la enfermedad de Graves.

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Authors and Affiliations

  1. Department of Surgery, St. John of God Medical Centre, Perth, Western Australia

    Michael D. Levitt M.B., B.S., Anthony J. Edis M.D., F.A.C.S., F.R.A.C.S., Ross Agnello F.R.A.C.S., F.R.A.C.O. & Clement C. McCormick F.R.A.C.R., F.R.C.R.

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  1. Michael D. Levitt M.B., B.S.
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  2. Anthony J. Edis M.D., F.A.C.S., F.R.A.C.S.
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  3. Ross Agnello F.R.A.C.S., F.R.A.C.O.
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  4. Clement C. McCormick F.R.A.C.R., F.R.C.R.
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Levitt, M.D., Edis, A.J., Agnello, R. et al. The effect of subtotal thyroidectomy on Graves' ophthalmopathy. World J. Surg. 12, 593–596 (1988). https://doi.org/10.1007/BF01655858

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