Effects of thyroidectomy alone or followed by radioiodine ablation of thyroid remnants on the outcome of Graves' ophthalmopathy

Fifty-five patients with Graves' disease (GD) and mild to moderate Graves' ophthalmopathy (GO) underwent near-total thyroidectomy (Tx). In 16 patients this was followed by a standard ablative dose of I-131 because of the hystologic evidence of differentiated thyroid carcinoma. We retrospectively evaluated whether or not GO activity could be affected by thyroid surgery alone or followed by complete ablation of thyroid tissue. Accordingly, on the basis of clinical activity score (CAS) values prior to thyroidectomy, we identified two groups: group A with active GO (CASgreater than or equal to3; n=31) and group B with inactive GO (CASless than or equal to2; n=24). CAS values were then recorded at 6, 12, and 24 months after surgery/I-131 ablation. Over the course of the follow-up period, GO became inactive in approximately 70% of group A patients (CAS 4.2+/-0.8 at baseline, 2.1+/-2.0 at 24 months, p<0.0001) and became active in 37.5% patients from group B. When we examined GO activity according to the type of treatment used (Tx or Tx and I-131), the prevalence of inactive GO both short- and long-term, was significantly higher in the group of patients who underwent Tx and I-131 ablation. Therefore, this seems to be a more effective means of inducing and maintaining inactive GO.