Endocrine Abstracts

Purpose: Graves’ disease is an autoimmune condition that can cause hyperthyroidism and thyroid eye disease (TED). Definitive treatment is required in approximately 50% patients. Thyroidectomy remains the least chosen primary treatment (2%-18%) despite it having the highest cure rate (>95%). Our aim was to determine the current relationship between patients’ TED and thyroidectomy in a multidisciplinary specialist eye clinic at a tertiary referral centre.

Methods: A retrospective review of medical records was performed for patients who underwent total surgical thyroidectomy at Oxford University Hospitals and/or were diagnosed with TED by the Oxford TED clinic between Jan 2011 – Nov 2019. Patients were divided into 3 groups for the purpose of data analysis: (1) all patients who underwent total thyroidectomy for non-malignant thyroid pathology, (2) all patients diagnosed with TED and (3) patients diagnosed with TED who underwent thyroidectomy. Patient demographics, smoking status, age at diagnosis, TED severity and medical therapy were recorded. Exclusion criteria included patients younger than18 years, incomplete data, thyroidectomy for neoplasia and no MDT-confirmed diagnosis of TED.

Results: Overall, 248 patients were included: 129 underwent thyroidectomy (Group 1), 168 were diagnosed with TED (Group 2), and 49 patients diagnosed with TED underwent thyroidectomy (Group 3). 29% of TED patients underwent a thyroidectomy. 38% of thyroidectomy patients had documented TED. Of all patients who underwent thyroidectomy, those with TED were significantly older (47 vs. 37 years, P<0.01) and more likely to smoke (47% vs. 28%, P<0.01).

Conclusions: This study demonstrates a paradigm shift in use of thyroidectomy in TED patients with double the proportion of TED patients undergoing thyroidectomy compared with similar studies pre-2015. Possible reasons include increasing use of an MDT TED approach, improved surgical thyroidectomy technique and access to thyroidectomy and reduced use of radioiodine in TED.