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1

Total Thyroidectomy in Treatment of Graves' Ophthalmopathy

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Konturek A., Barczyński M., Cichoń S., Anielski R., Cichoń W., Jonkisz J., Orlicki P.

Polish Journal of Surgery

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2008

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vol. 80

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issue 9

455-464

EN

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

2

Association analysis of vitamin D receptor gene polymorphisms with bone mineral density in young women with Graves' disease

80%

Horst-Sikorska W., Ignaszak-Szczepaniak M., Marcinkowska M., Kaczmarek M., Stajgis M., Slomski R.

Acta Biochimica Polonica

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2008

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vol. 55

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issue 2

371-380

EN

Graves' (GD) hyperthyroidism induces accelerated bone turnover that leads to decreased bone mineral density (BMD). The role of the VDR gene in predisposition to primary osteoporosis has been recognized. Recent studies show associations between the VDR gene polymorphisms and susceptibility to autoimmune diseases. Here we analyzed if VDR gene polymorphisms: BsmI, ApaI, TaqI, and FokI may predispose women with Graves' hyperthyroidism to BMD reduction or to disease development. The subjects were 75 premenopausal female Polish patients with GD and 163 healthy women. The genotyping was performed by the use of the restriction fragment length polymorphism analysis (RFLP). We studied the association of the VDR polymorphisms and their haplotypes with patients' BMD and also SNPs and haplotypes association with Graves' disease. We found a strong linkage disequilibrium for the BsmI, ApaI, and TaqI polymorphims that formed three most frequent haplotypes in Graves' women: baT (47.9%), BAt (34.9%), and bAT (16.4%). We did not show statistically significant association of analyzed VDR polymorphisms or haplotypes with decreased bone mineral density in Graves' patients. However, the presence of F allele had a weak tendency to be associated with Graves' disease (with OR=1.93; 95% CI: 0.97-3.84; p=0.058). In conclusion: VDR gene polymorphisms do not predict the risk of decreased BMD in Polish women with Graves'. It may be speculated that the F allele carriers of the VDR-FokI polymorphism are predisposed to Graves' disease development.

3

Association between estrogen receptor alpha gene polymorphisms and bone mineral density in Polish female patients with Graves' disease

80%

Ignaszak-Szczepaniak M., Horst-Sikorska W., Dytfeld J., Gowin E., Słomski R., Stajgis M.

Acta Biochimica Polonica

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2011

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vol. 58

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issue 1

101-109

EN

Graves' (GD) hyperthyroidism leads to reduced bone mineral density (BMD) accompanied by accelerated bone turnover. Ample studies have identified association between estrogen receptor (ESR1) gene polymorphism and decreased BMD and osteoporosis. In contrast, number of publications that link ESR1, BMD and Graves' disease is limited. The purpose of this study was to identify the association between ESR1 polymorphisms and BMD in premenopausal women with GD and to determine whether ESR1 polymorphic variants can predispose to GD. The study included 75 women aged 23-46 years with GD and 163 healthy controls. BMD was measured at lumbar spine and femoral neck. We investigated two SNPs in the ESR1 gene and analyzed genetic variants in the form of haplotypes reconstructed by statistical method. Three out of four possible haplotypes of the PvuII and XbaI restriction fragment length polymorphisms were found in GD patients: px (55.3 %), PX (33.3 %) and Px (11.4 %). Women homozygous for xx of XbaI and for pp of PvuII had the lowest BMD at lumbar spine. Moreover, the px haplotype predisposed to reduced lumbar BMD. No associations were observed for femoral neck BMD. No statistically significant relationship were found between ESR1 polymorphisms or their haplotypes and GD. These results indicate that the PvuII and the XbaI polymorphisms of ESR1 gene are associated with bone mineral density in premenopausal women with GD and may help to estimate the risk of bone loss particularly at lumbar spine. However, none of the ESR1 gene alleles predict the risk of GD in Polish female patients.

4

Influence of Total Thyroidectomy on Orbital Opthalmopathy and Levels of Antithyroid Antibodies in Patients with Graves' Disease

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Domosławski P., Łukieńczuk T., Forkasiewicz Z., Balcerzak W., Bednarz W., Dawiskiba J., Krawczyk Z., Wojtczak B., Olewiński R., Podhorska-Okołów M.

Polish Journal of Surgery

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2007

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vol. 79

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issue 3

167-172

EN

Graves' disease is an autoimmune disease. One of the most severe complications of Graves' disease is orbitopathy.The aim of the study was to estimate the influence of total thyroidectomy on the postoperative course of exophthalmus and determine the levels of thyroid antibodies after surgery.Material and methods. During the period between 2002 and 2005, 1514 strumectomies were performed at the I Chair and Department of General, Gastroenterological and Endocrine Surgery, Medical University in Wroclaw. The study included 69 (4.5%) patients, who were operated on because of Graves' disease. Forty-two (60%) of these patients had progressive opthalmopathy and were subjected to total thyroidectomy (35 women and 7 men, mean age was 31 years). The diagnosis of Graves' disease was established on the basis of the clinical evaluation, fT3, fT4 and TSH values, as well as the determination of serum thyroid antibody levels. Every patient was subjected to an opthalmological examination, with measurements of the degree of exopthalmus, as compared to the ATA (American Thyroid Association) scale. Above-mentioned parameters were measured before surgery and 6, 12 and 18 months after total thyroidectomy.Results. Considering patients after total thyroidectomy, exophthalmus did not proceed. In 17 (40%) patients, 2- 3 mm of eyeball retraction was noted, mainly during the initial six months. After surgery, a statistically significant reduction of TSH-receptor and anti-TPO antibody values were observed.Conclusions. Total thyroidectomy in patients with Graves' disease and orbital opthalmopathy significantly reduced the progression of orbitopathy. It also leads to the normalization of serum anti-recepor (TRAb) and anti-peroxidase (anti-TPO) antibody levels.Total thyroidectomy is a quick and effective procedure in the hands of an experienced surgeon and should be performed in secondary or tertiary care centers.

5

Own Experience in Treatment of Autoimmune Goiter in the Last Decade

80%

Rudzki S., Matuszek M., Nowakowski A., Matuszek B., Matras P., Wojewoda K.

Polish Journal of Surgery

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2010

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vol. 82

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issue 2

63-68

EN

The aim of the study. The study was intended to be a retrospective analysis of clinical data concerning patients operated on for autoimmune goitre in the period 1998-2008, in the 1st Department of General and Transplant Surgery of the Medical University in Lublin.Material and methods. 1157 patients were operated on for various goitre forms. This group included 134 patients with Graves' and Hashimoto's disease associated goitre, which accounted for 11% of all goitre patients undergoing the surgery. Major indications to surgical treatment of the Graves' disease included progressive exophthalmos, goitre with compression symptoms, hoarseness, and uncertain biopsy diagnoses. As regards Hashimoto's disease, goitre with compression symptoms or with tumour-like changes, and ambiguous biopsy diagnoses were the factors qualifying the patient for surgical treatment. Statistical analysis was conducted using STATISTICA 6.0 PL software, the chi2 test was performed, and the statistical significance was established at p<0.005.Results. Graves' disease associated goitre was operated on in 72 patients, including 53 cases (39.5%) where infiltrative ophthalmopathy was also observed. Hashimoto's disease associated goitre was operated on in 62 patients. Early paralysis of the recurrent laryngeal nerve occurred in 10 (13.9%) patients operated on for Graves' disease, and in 5 (8.1%) patients operated on for Hashimoto's disease. As regards patients operated on for non-autoimmune goitre, early paralysis of the recurrent laryngeal nerve was observed in 29 (3%) cases. Post-surgical tetany was observed in 11.1% of Graves' disease patients, and in 8% of Hashimoto's disease patients. Finally, temporary post-surgical tetany was found in 2% of patients with non-autoimmune goitre.Conclusions. The type of goitre being operated on has a significant impact on the incidence of early post-surgical complications. In general, the incidence of early post-surgical complications is higher in the case of patients operated on for autoimmune-type goitre, compared with patients with non-autoimmune goitre. Yet this method is both safe and efficient. Total thyroid removal should be the treatment applied in the case of progressive orbitopathy associated with Graves' disease.

6

Graves' disease, celiac disease and liver function abnormalities in a patient - clinical manifestation and diagnostic difficulties

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Góra-Gębka M., Woźniak M., Cielecka-Kuszyk J., Korpal-Szczyrska M., Sznurkowska K., Zagierski M., Jankowska I., Plata-Nazar K., Kamińska B., Liberek A.

Acta Biochimica Polonica

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2014

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vol. 61

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issue 2

281-284

EN

Autoimmune diseases due to probable common pathogenesis tend to coexist in some patients. Complex clinical presentation with diverse timing of particular symptoms and sophisticated treatment with numerous side effects, may cause diagnostic difficulties, especially in children. The paper presents diagnostic difficulties and pitfalls in a child with Graves' disease, celiac disease and liver function abnormalities.

7

CTLA-4 polymorphisms (+49 A/G and -318 C/T) are important genetic determinants of AITD susceptibility and predisposition to high levels of thyroid autoantibodies in Polish children - preliminary study

61%

Pastuszak-Lewandoska D., Domańska D., Rudzińska M., Bossowski A., Kucharska A., Sewerynek E., Czarnecka K., Migdalska-Sęk M., Czarnocka B.

Acta Biochimica Polonica

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2013

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vol. 60

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issue 4

641-646

EN

Autoimmune thyroid diseases (AITDs), including Hashimoto' s thyroiditis (HT) and Graves' disease (GD), are related to environmental and genetic factors. We analyzed the association of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) gene two polymorphisms (+49 A/G, -318 C/T) with HT and GD development in Polish children, and correlated both polymorphisms with the production of thyroid autoantibodies (TPOAb and TgAb). The study involved 49 AITD patients (age 10-19) with HT (n=25) or GD (n=24) and 69 healthy controls. SNP genotyping was performed using genomic DNA and TaqMan® probes. The obtained results indicated that CTLA-4 +49 GG genotype was significantly more frequent in both HT and GD patients, whereas the AA genotype was more common in controls. CTLA-4-318 CT genotype was significantly more frequent in AITD, and the CC genotype more often occurred in controls. Significantly higher median TPOAb and TgAb values were associated with G allele in HT, and with T allele in GD patients. Concluding, both studied polymorphisms seem to be important genetic determinants of the risk of HT and GD, and appear to be associated with a predisposition to high levels of TAbs and clinical AITD. The obtained results give more information on the distribution of the CTLA-4 polymorphism in Polish AITD children, and further support the proposal that the CTLA-4 gene plays an important role in a TAb production.

8

Factors affecting the course of Graves' orbitopathy and poor response to glucocorticoid treatment followed by orbital radiotherapy

61%

Jagiełło-Korzeniowska A., Sokołowski A., Hubalewska-Dydejczyk A., Romanowska-Dixon B., Bałdys-Waligórska A.

OphthaTherapy

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2022

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vol. 9

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issue 2

98-105

EN

Graves’ orbitopathy is a rare autoimmune disorder characterized by the inflammation of orbital tissues. The course of disease can be described in terms of its activity and severity. Aim: The aim of our study was to determine the factors affecting the activity and severity of Graves’ orbitopathy, as well as to identify the predictive factors of poor response to glucocorticoid treatment followed by orbital irradiation. Methods: We performed a prospective observational study of 214 patients with Graves’ orbitopathy who were divided into two groups depending on the treatment they had previously obtained for their Graves’ disease. They received i.v. methylprednisolone pulses followed by orbital radiotherapy. They were examined and had their TSH, TRAb and FT4 levels evaluated prior to treatment and after 1, 6 and 12 months. Results: A pre-treatment TRAb concentration higher by one unit (U/L) implied a mean increase in the relative risk of active orbitopathy by 4.7% (p = 0.0362). A TRAb concentration higher by one U/L 1 month after treatment implied a mean increase in the relative risk of moderate-to-severe and severe GO by 8.7% (p = 0.0167) 6 months after treatment. As regards poor response to treatment, patients with moderate-to-severe and severe Graves’ orbitopathy on admission carried a higher risk of being non-responders. Each point scored on the NOSPECS scale prior to treatment increased the relative risk of the patient being a non-responder by 30%. Conclusions: Patients with higher TRAb levels have a higher risk of active Graves’ orbitopathy and moderate-to-severe and severe Graves’ orbitopathy. Monitoring TRAb serum concentration in those patients is of great importance. Patients with more severe Graves’ orbitopathy carry a higher risk of being poor responders to immunosuppressive treatment. Therefore, careful monitoring of patients with Graves’ orbitopathy and their early referral to specialized centers is essential.

Refine search results

Total Thyroidectomy in Treatment of Graves' Ophthalmopathy

Association analysis of vitamin D receptor gene polymorphisms with bone mineral density in young women with Graves' disease

Association between estrogen receptor alpha gene polymorphisms and bone mineral density in Polish female patients with Graves' disease

Influence of Total Thyroidectomy on Orbital Opthalmopathy and Levels of Antithyroid Antibodies in Patients with Graves' Disease

Own Experience in Treatment of Autoimmune Goiter in the Last Decade

Graves' disease, celiac disease and liver function abnormalities in a patient - clinical manifestation and diagnostic difficulties

CTLA-4 polymorphisms (+49 A/G and -318 C/T) are important genetic determinants of AITD susceptibility and predisposition to high levels of thyroid autoantibodies in Polish children - preliminary study

Factors affecting the course of Graves' orbitopathy and poor response to glucocorticoid treatment followed by orbital radiotherapy