ECE2006 Poster Presentations Thyroid (174 abstracts)
Favourable outcome of Graves’ ophthalmopathy (GO) after glucocorticoids (GC) in patients treated with total thyroid ablation (TTA): results of a randomized clinical trial
FM Menconi 1 , MM Marinò 1 , LB Bartalena 3 , RR Rocchi 1 , MN Nardi 2 , AP Pinchera 1 & CM Marcocci 1
1Departments of Endocrinology, University of Pisa, Italy; 2Departments of Neuroscience, University of Pisa, Italy; 3Chair of Endocrinology, University of Insubria, Varese, Italy.
Whether TTA affects GO remains to be established. Here we studied the effects of TTA in 90 patients with mild-moderate GO randomized into 3 groups of thyroid treatment: MMI (methimazole), TX [near-total thyroidectomy (NTTX)], TTA (NTTX plus 131-I). Patients were treated with ivGC and evaluated at 3 and 9 mo. GO was considered improved or worsened when at least 2 of the following criteria changed, either positively or negatively: i) proptosis and/or eyelid width by at least 2 mm; ii) clinical activity score by at least 2/7 points; iii) diplopia: progressed, reduced, appeared or disappeared. GO was otherwise considered stable. At baseline, TX and TTA groups were homogeneous for thyroid volume, serum Tg, TgAb, TPOAb, TBII, degree and activity of GO. However, for unknown reasons, MMI patients had significantly lower thyroid volumes and proptosis. Because these parameters affected GO independently, this group was excluded. At the end of the study a random sample of TX and TTA patients withdraw LT4 and underwent RAI uptake and Tg assay. Complete ablation in the TTA group was confirmed by the lower mean RAI uptake (3 h: 0.7 vs 1.5%, P=0.018; 24 h: 0.28 vs 2.9%, P=0.0006) and Tg levels (0.3 vs 4.0 ng/ml, P=0.008). 3 mo. after GC, GO improved in 33.3% of TTA and 22% of TX patients, but the difference was not significant. At 9 mo., GO improved in a significantly (P=0.0189) greater proportion of TTA (55.5%) than TX patients (20.0%). GO worsened in a lower proportion of TTA patients both at 3 (7.4% vs 14.8%) and 6 mo. (7.4 vs 16%), but the difference was not significant. In conclusion, TTA has a beneficial effect on the short term outcome of GO following GC compared with TX. Thus, TTA should be a first choice thyroid treatment in GO patients undergoing thyroid surgery.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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