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

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, 23 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.