Thyroid Research Thyroid Research Archive Graves’ Ophthalmopathy

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