Full-text resources of PSJD and other databases are now available in the new Library of Science.
Visit https://bibliotekanauki.pl


Preferences help
enabled [disable] Abstract
Number of results
2008 | 80 | 9 | 455-464

Article title

Total Thyroidectomy in Treatment of Graves' Ophthalmopathy


Title variants

Languages of publication



The aim of the study. The present report is an attempt at answering the question regarding the ocular status in the course of thyroid ophthalmopathy following surgical treatment. A retrospective analysis included a group of patients presenting with various ophthalmologic symptoms in the course of Graves' disease. The analysis focused on the clinical ophthalmologic status determined based on eye examinations and determinations of the level of thyroid stimulating hormone receptor antibody (TRAb), as well as on changes in the above parameters in pre and postoperative examinations.Material and methods. Between January 2005 and December 2006, 61 patients were managed surgically for Graves' disease. The group consisted of 53 (86.9%) females and eight (13.1%) males. Their mean age was 45.5±12 years, with the range of 18 to 71 years. Prior to surgery, the mean duration of pharmacotherapy was 27.3 months, with the range of 3-120 months. The severity of the disease was determined using the NOSPECS classification and the resultant ophthalmopathy index according to Donaldson. Ocular symptoms were assessed prior to treatment and subsequently at 3, 6 and 12 months after thyroidectomy. Determinations of TSH, fT4 and antithyroid antibodies TRAb were done in all the patients before and 12 months after surgical treatment. In the present investigations, determinations of the thyroid stimulating hormone receptor antibody (TRAb) levels were done by radioimmunoassay.Results. All the 61 patients were treated surgically. The following procedures were performed: total thyroidectomies in 35 (57.4%) patients, the so-called Dunhill operations (total lobectomy plus subtotal resection of the contralateral side) in 14 (23%), and subtotal bilateral lobectomies in 12 (19.6%) subjects. Determinations of thyroid stimulating hormone receptor antibody TRAb levels were done preoperatively in 61 (100%) patients and postoperatively in 54 (88.5%) individuals. In the present series, preoperative TRAb values were significantly elevated (>2 IU/L) in as many as 56 (91.8%) patients. After the surgery, TRAb normalized in 35 (57.4%) patients (<1 IU/L - absent) from 9.14±10.7 to 0.95±0.45 IU/L (p<0.001, test t). The differences are statistically significant. Borderline antibody values (between 1 and 2 IU/l) were noted in 5 (8.1%) patients before and in 18 (29.5%) after the procedure. The ophthalmologic assessment based on the Donaldson ophthalmopathy index, which combines scores awarded while evaluating five classes (soft tissues, degree of exophthalmus, oculomotor muscle status, corneal status, visual acuity) included 54 (88.5%) of 61 patients. The value of the index changed in the entire investigated group, what was manifested in a statistically significant decrease in the ophthalmopathy index from 6.1±2.32 prior to treatment to 3.31±2.09 after the surgery (p<0.001, test t). Deterioration of the general ocular status as confirmed by the initial ophthalmopathy index was confirmed by ophthalmology in five patients. Subjective complaints of deteriorated vision were reported by three patientsConclusions. The use of ultrasonic scalpel in thyroid surgery a reduction of mean operating time, achieving good hemostasis and improved cosmetic results without increased risk of morbidity








Physical description


1 - 9 - 2008
25 - 9 - 2008


  • Department of Endocrine Surgery, 3 Chair of General Surgery, Jagiellonian University College of Medicine, Cracow
  • Department of Endocrine Surgery, 3 Chair of General Surgery, Jagiellonian University College of Medicine, Cracow
  • Department of Endocrine Surgery, 3 Chair of General Surgery, Jagiellonian University College of Medicine, Cracow
  • Department of Endocrine Surgery, 3 Chair of General Surgery, Jagiellonian University College of Medicine, Cracow
  • Department of Endocrine Surgery, 3 Chair of General Surgery, Jagiellonian University College of Medicine, Cracow
  • Department of Endocrine Surgery, 3 Chair of General Surgery, Jagiellonian University College of Medicine, Cracow
  • Department of Endocrine Surgery, 3 Chair of General Surgery, Jagiellonian University College of Medicine, Cracow


  • Marcocci C, Bartalena L, Pinchera A: Ablative or non-ablative therapy for Graves' hyperthyroidism in patients with ophthalmopathy? J of Endocrin Invest 1998; 21: 468-71.
  • Bartalena L, Marcocci C, Bogazzi F et al.: Use of corticosteroids to prevent progression of Graves' ophthalmopathy after radioiodine therapy for hyperthyroidism. New Eng J Med 1989; 321: 1349-52.
  • Barakate MS, Agarwal G, Reeve TS et al.: Total thyroidectomy is now the preferred option for the surgical management of Graves' disease ANZ J Surg 2002; 72: 321-24.
  • Kurihara H: Total thyroidectomy for the treatment of hyperthyroidism in patients with ophthalmopathy. Thyroid 2002; 12: 265-67.[PubMed][Crossref]
  • Alsanea O, Clark OH: Treatment of Graves' disease: the advantages of surgery. Endocrinol Metab Clin North Am 2000; 29: 321-37.[Crossref][PubMed]
  • Bellantone R, Lombardi CP, Bossola M et al.: Total thyroidectomy for management of benign thyroid disease: review of 526 cases. World J Surg 2002; 26: 1468-71.[Crossref]
  • Janowska J, Widala E, Zych F: Przeciwciała przeciw receptorowi dla TSH w wolu nawrotowym po operacyjnym leczeniu choroby Gravesa-Basedowa. Pol Merkuriusz Lek 1998; 4(23): 257.
  • Winsa B, Rastad J, Åkerström G et al.: Retrospective evaluation of subtotal and total thyroidectomy in Graves' disease with and without endocrine ophthalmopathy. Europ J Endocrinol 1995; 132: 406-12.
  • Perzik SL: Place of total thyroidectomy in the menagement of 900 patients with thyroid disease. Am J Surg 1976, 132, 480.
  • Kiliański J, Nauman J: Diagnostyka i leczenie Oftalmopatii Gravesa-Basedowa. Endokrynol Pol 2002; 53(Suppl do Nr): 97-118.
  • Bednarczuk T: Związek pomiędzy polimorfizmami wybranych genów i rozwojem oftalmopatii u pacjentów z chorobą Gravesa-Basedowa w populacji polskiej. Endokrynol Pol 2004; 3(55): 275-98.
  • Forbes G, Gorman CA, Brennan MD et al.: Ophthalmopathy of Graves' disease: computerized volume measurements of the orbital fat and muscle. Am J Neuroradiol 1986; 7: 651-56.
  • Cawood T, Moriarty P, O'Shea D: Recent developments in thyroid eye disease. BMJ 2004; 329: 385-90.
  • Kiljański J: Opieka nad chorymi z objawami ocznymi towarzyszącymi autoimmunologiczym chorobom tarczycy. Terapia 1999; 7 (5): 11-15.
  • Sewerynek E: Rozpoznanie i leczenie objawów ocznych w przebiegu chorób tarczycy o podłożu autoimmunologicznym. Forum Medycyny Rodzinnej 2007; tom 1, nr 2, 143-51.
  • Cichoń S, Barczyński M, Pituch-Noworolska A: Nowe spojrzenie na czynność tarczycy po leczeniu operacyjnym choroby Gravesa i Basedowa. Przedkliniczna niedoczynność - zjawisko trwałe czy przemijające. Pol Przegl Chir 1996; 68: 179.
  • Witte J, Goretzki PE, Dotzenrath C et al.: Surgery for Graves' disease: total versus subtotal thyroidectomy-results of a prospective randomized trial. World J Surg 2000; 24(11): 1303-11.[PubMed][Crossref]
  • DeGroot LJ, Benjasuratwong Y: Evaluation of thyroid ablative therapy for ophthalmopathy of Graves' disease. Orbit 1996; 15: 187.[Crossref]
  • DeGroot LJ, Gorman CA, Pinchera A et al.: Therapeutic controversies: Radiation and Graves' ophthalmopathy. J Clin Endocrinol Metab 1995; 80: 339.[PubMed][Crossref]
  • Gorman CA: Radioiodine therapy does not aggravate Graves' ophthalmopathy. J Clin Endocrinol Metab 1995; 80: 340.[Crossref][PubMed]
  • Weetman AP, Wiersinga WM: Current management of thyroid-associated ophthalmopathy in Europe. Results of an international survey. Clin Endocrinol (Oxf). 1998; 49(1): 21-28.[Crossref]
  • Bartalena L, Pinchera A, Marcocci C: Management of Graves' ophthalmopathy: reality and perspectives. Endocrine Reviews 2000; 21: 168-99.[PubMed]
  • Bartalena L, Marcocci C, Pinchera A: Graves' ophathalmopathy: a preventable disease? Eur J Endocrinol 2002; 146: 457-61.[Crossref][PubMed]
  • Lewiński A, Makarewicz J, Adamczewski Z i wsp.: Oftalmopatia Gravesa - diagnostyka i leczenie. Endocrinol Pol 2002; 53 (supl. 1): 33-46.
  • Tallstedt L, Lundell G, Torring O et al.: Occurrence of ophthalmopathy after treatment for Graves' hyperthyroidism. The Thyroid Study Group. N Engl J Med 1992; 326: 1733-38.
  • Prummel MF: Graves' ophthalmopathy: diagnosis and management. Eur J Nucl Med 2000; 27: 373-76.[PubMed][Crossref]
  • De Groot LJ: Radioiodine and the immune system. Thyroid 1997; 7: 259-64.[Crossref]
  • Pinchera A, Bartalena L, Marcocci C: Therapeutic controversies: radiation and Graves' ophtalmopathy. J Clin Endocrinol Metab 1995; 80: 342-44.[Crossref]
  • Marcocci C, Bartalena L, Bogazzi F et al.: Radioiodine and thyroid-associated ophthalmopathy. Orbit 1996, 15: 197.[Crossref]
  • Marcocci C, Bartalena L, Bogazzi F et al.: Relationship between Graves' ophthalmopathy and type of treatment of Graves' hyperthyroidism. Thyroid 1992; 2(2): 171-78.[Crossref][PubMed]
  • Tallstedt L, Lundell G, Blomgren H et al.: Does early administration of thyroxine reduce the devlopment of Graves' ophthalmopathy after radioiodine treatment? Europ J Endocrinol 1994; 130: 494-97.
  • Wiersing WM: Oftalmopatia Gravesa. Thyroid International - Merck, 1998; 2.
  • Weetman AP: Autoimmune thyroiditis: predisposition and pathogenesis. Clin Endocrinol 1992; 36: 307.[Crossref]
  • Michelangeli VP, Poon C, Topliss DJ: Specyfic effects of radioiodine treatment on TSAb and TSAb levels in patients with Graves' disease. Thyroid 1995; 5: 171.
  • Mori Y, Matoba N, Miura S et al.: Clinical course and thyroid stimulating hormone (TSH) receptor antibodies during surgical treatment of Graves' disease. World J of Surg 1992; 16(4).
  • Aizawa Y et al.: Long-term effects of radioiodine on thyrotropin receptor antibodies in Graves' disease. Clin Endocrinol (Oxf) 1995; 4: 517-22.

Document Type

Publication order reference


YADDA identifier

JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.