PDF herunterladen
Horm Metab Res 2016; 48(07): 433-439
DOI: 10.1055/s-0042-108855
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

The Effect of Early Thyroidectomy on the Course of Active Graves’ Orbitopathy (GO): A Retrospective Case Study

M. Meyer zu Horste
1   Center for Ophthalmology, Department of Neuroophthalmology and Strabismus, University of Duisburg-Essen, Essen, Germany
2   Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
,
K. Pateronis
1   Center for Ophthalmology, Department of Neuroophthalmology and Strabismus, University of Duisburg-Essen, Essen, Germany
,
M. K. Walz
3   Department of Surgery and Center for Minimal Invasive Surgery, Huyssen-Stift Essen, Essen, Germany
,
P. Alesina
3   Department of Surgery and Center for Minimal Invasive Surgery, Huyssen-Stift Essen, Essen, Germany
,
K. Mann
4   Center for Internal Medicine, Department of Endocrinology, University of Essen, Essen, Germany
,
M. Schott
5   Center for Internal Medicine, Department of Endocrinology, Diabetology and Rheumatology, University Duesseldorf, Duesseldorf, Germany
,
J. Esser
1   Center for Ophthalmology, Department of Neuroophthalmology and Strabismus, University of Duisburg-Essen, Essen, Germany
,
A. K. Eckstein
1   Center for Ophthalmology, Department of Neuroophthalmology and Strabismus, University of Duisburg-Essen, Essen, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 18. Februar 2016

accepted 12. Mai 2016

Publikationsdatum:
28. Juni 2016 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Abstract

The aim of the work was to investigate the effect of early thyroidectomy on the course of active Graves’ orbitopathy (GO) in patients with low probability of remission [high TSH receptor antibody (TRAb) serum levels, severe GO] compared to that of continued therapy with antithyroid drugs. Two cohorts were evaluated retrospectively (total n=92 patients with active GO, CAS≥4). Forty-six patients underwent early thyroidectomy (Tx-group) 6±2 months after initiation of antithyroid drug (ATD) therapy, while ATD was continued for another 6±2 months in the ATD-group (n=46). These controls were consecutively chosen from a database and matched to the Tx-group. GO was evaluated (activity, severity, TRAb) at baseline and at 6 month follow-up. At baseline, both cohorts were virtually identical as to disease severity, activity and duration, as well as prior anti-inflammatory treatment, age, gender, and smoking behavior. At 6 month follow-up, NOSPECS severity score was significantly decreased within each group, but did not differ between both groups. However, significantly more patients of the Tx-group presented with inactive GO (89.1 vs. 67.4%, * p=0.02), and mean CAS score was significantly lower in Tx-group (2.1) than in ADT-group (2.8; * p=0.02) at the end of follow-up. TRAb levels declined in both groups (Tx-group: from 18.6 to 5.2 vs. ATD-group: 12.8–3.2 IU/l, p0=0.07, p6months=0.32). Residual GO activity was lower in Tx-group, associated with a higher rate of inactivation of GO. This allows an earlier initiation of ophthalmosurgical rehabilitation in patients with severe GO, which may positively influence quality of life of the patients.

Key words

thyroid treatment - thyroidectomy - ATD - course of GO
 

  • References

  • 1 Bahn RS. Graves’ ophthalmopathy. N Engl J Med 2010; 362: 726-738
    Google Scholar
  • 2 Bahn RS. Current Insights into the Pathogenesis of Graves’ Ophthalmopathy. Horm Metab Res 2015; 47: 773-778
    Google Scholar
  • 3 Salvi M, Campi I. Medical Treatment of Graves’ Orbitopathy. Horm Metab Res 2015; 47: 779-788
    Google Scholar
  • 4 Bartalena L, Baldeschi L, Dickinson A, Eckstein A, Kendall-Taylor P, Marcocci C, Mourits M, Perros P, Boboridis K, Boschi A, Curro N, Daumerie C, Kahaly GJ, Krassas GE, Lane CM, Lazarus JH, Marino M, Nardi M, Neoh C, Orgiazzi J, Pearce S, Pinchera A, Pitz S, Salvi M, Sivelli P, Stahl M, von Arx G, Wiersinga WM. Consensus statement of the European Group on Graves’ orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol 2008; 158: 273-285
    CrossrefPubMedGoogle Scholar
  • 5 Piantanida E, Lai A, Sassi L, Gallo D, Spreafico E, Tanda ML, Bartalena L. Outcome Prediction of Treatment of Graves’ Hyperthyroidism with Antithyroid Drugs. Horm Metab Res 2015; 47: 767-772
    Google Scholar
  • 6 Orgiazzi J, Madec AM. Reduction of the risk of relapse after withdrawal of medical therapy for Graves’ disease. Thyroid 2002; 12: 849-853
    CrossrefPubMedGoogle Scholar
  • 7 Eckstein A, Mann K, Kahaly GJ, Grussendorf M, Reiners C, Feldkamp J, Quadbeck B, Bockisch A, Schott M. Role of TSH receptor autoantibodies for the diagnosis of Graves’ disease and for the prediction of the course of hyperthyroidism and ophthalmopathy. Recommendations of the Thyroid Section of the German Society of Endocrinology. Med Klin (Munich) 2009; 104: 343-348
    CrossrefPubMedGoogle Scholar
  • 8 Schott M, Morgenthaler NG, Fritzen R, Feldkamp J, Willenberg HS, Scherbaum WA, Seissler J. Levels of autoantibodies against human TSH receptor predict relapse of hyperthyroidism in Graves’ disease. Horm Metab Res 2004; 36: 92-96
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 9 Eckstein AK, Lax H, Losch C, Glowacka D, Plicht M, Mann K, Esser J, Morgenthaler NG. Patients with severe Graves’ ophthalmopathy have a higher risk of relapsing hyperthyroidism and are unlikely to remain in remission. Clin Endocrinol (Oxf) 2007; 67: 607-612
    Google Scholar
  • 10 Catz B, Perzik SL. Total thyroidectomy in the management of thyrotoxic and euthyroid Graves’ disease. Am J Surg 1969; 118: 434-439
    CrossrefPubMedGoogle Scholar
  • 11 Tallstedt L, Lundell G, Torring O, Wallin G, Ljunggren JG, Blomgren H, Taube A. Occurrence of ophthalmopathy after treatment for Graves’ hyperthyroidism. The Thyroid Study Group. N Engl J Med 1992; 326: 1733-1738
    Google Scholar
  • 12 Witte J, Goretzki PE, Dotzenrath C, Simon D, Felis P, Neubauer M, Roher HD. Surgery for Graves’ disease: total versus subtotal thyroidectomy-results of a prospective randomized trial. World J Surg 2000; 24: 1303-1311
    CrossrefPubMedGoogle Scholar
  • 13 Frilling A, Goretzki PE, Grussendorf M, Erbsloh M, Roher HD. The influence of surgery on endocrine ophthalmopathy. World J Surg 1990; 14: 442-445 discussion 445–446
    CrossrefPubMedGoogle Scholar
  • 14 Marcocci C, Bruno-Bossio G, Manetti L, Tanda ML, Miccoli P, Iacconi P, Bartolomei MP, Nardi M, Pinchera A, Bartalena L. The course of Graves’ ophthalmopathy is not influenced by near total thyroidectomy: a case-control study. Clin Endocrinol (Oxf) 1999; 51: 503-508
    CrossrefPubMedGoogle Scholar
  • 15 De Bellis A, Conzo G, Cennamo G, Pane E, Bellastella G, Colella C, Iacovo AD, Paglionico VA, Sinisi AA, Wall JR, Bizzarro A, Bellastella A. Time course of Graves’ ophthalmopathy after total thyroidectomy alone or followed by radioiodine therapy: a 2-year longitudinal study. Endocrine 2012; 41: 320-326
    CrossrefPubMedGoogle Scholar
  • 16 Moleti M, Violi MA, Montanini D, Trombetta C, Di Bella B, Sturniolo G, Presti S, Alibrandi A, Campenni A, Baldari S, Trimarchi F, Vermiglio F. Radioiodine ablation of postsurgical thyroid remnants after treatment with recombinant human TSH (rhTSH) in patients with moderate-to-severe graves’ orbitopathy (GO): a prospective, randomized, single-blind clinical trial. J Clin Endocrinol Metab 2012; 99: 1783-1789
    PubMedGoogle Scholar
  • 17 Tanda ML, Piantanida E, Liparulo L, Veronesi G, Lai A, Sassi L, Pariani N, Gallo D, Azzolini C, Ferrario M, Bartalena L. Prevalence and natural history of Graves’ orbitopathy in a large series of patients with newly diagnosed graves’ hyperthyroidism seen at a single center. J Clin Endocrinol Metab 2013; 98: 1443-1449
    Google Scholar
  • 18 Bartalena L, Macchia PE, Marcocci C, Salvi M, Vermiglio F. Effects of treatment modalities for Graves’ hyperthyroidism on Graves’ orbitopathy: a 2015 Italian Society of Endocrinology Consensus Statement. J Endocrinol Invest 2015; 38: 481-487
    CrossrefPubMedGoogle Scholar
  • 19 Menconi F, Leo M, Vitti P, Marcocci C, Marino M. Total thyroid ablation in Graves’ orbitopathy. J Endocrinol Invest 2015; 38: 809-815
    CrossrefPubMedGoogle Scholar
  • 20 Mourits MP, Prummel MF, Wiersinga WM, Koornneef L. Clinical activity score as a guide in the management of patients with Graves’ ophthalmopathy. Clin Endocrinol (Oxf) 1997; 47: 9-14
    Google Scholar
  • 21 Eckstein AK, Plicht M, Lax H, Hirche H, Quadbeck B, Mann K, Steuhl KP, Esser J, Morgenthaler NG. Clinical results of anti-inflammatory therapy in Graves’ ophthalmopathy and association with thyroidal autoantibodies. Clin Endocrinol (Oxf) 2004; 61: 612-618
    CrossrefPubMedGoogle Scholar
  • 22 Costagliola S, Morgenthaler NG, Hoermann R, Badenhoop K, Struck J, Freitag D, Poertl S, Weglohner W, Hollidt JM, Quadbeck B, Dumont JE, Schumm-Draeger PM, Bergmann A, Mann K, Vassart G, Usadel KH. Second generation assay for thyrotropin receptor antibodies has superior diagnostic sensitivity for Graves’ disease. J Clin Endocrinol Metab 1999; 84: 90-97
    CrossrefPubMedGoogle Scholar
  • 23 Bartalena L, Tanda ML, Piantanida E, Lai A, Pinchera A. Relationship between management of hyperthyroidism and course of the ophthalmopathy. J Endocrinol Invest 2004; 27: 288-294
    CrossrefPubMedGoogle Scholar
  • 24 Hegedus L, Bonnema SJ, Smith TJ, Brix TH. Treating the thyroid in the presence of Graves’ ophthalmopathy. Best Pract Res 2012; 26: 313-324
    CrossrefPubMedGoogle Scholar
  • 25 Prummel MF, Wiersinga WM, Mourits MP, Koornneef L, Berghout A, van der Gaag R. Effect of abnormal thyroid function on the severity of Graves’ ophthalmopathy. Arch Intern Med 1990; 150: 1098-1101
    CrossrefPubMedGoogle Scholar
  • 26 Bartalena L, Marcocci C, Pinchera A. On the effects of radioiodine therapy on Graves’ ophthalmopthy. Thyroid 1998; 8: 533-534
    CrossrefPubMedGoogle Scholar
  • 27 Takasu N, Yamashiro K, Komiya I, Ochi Y, Sato Y, Nagata A. Remission of Graves’ hyperthyroidism predicted by smooth decreases of thyroid-stimulating antibody and thyrotropin-binding inhibitor immunoglobulin during antithyroid drug treatment. Thyroid 2000; 10: 891-896
    CrossrefPubMedGoogle Scholar
  • 28 Elbers L, Mourits M, Wiersinga W. Outcome of very long-term treatment with antithyroid drugs in Graves’ hyperthyroidism associated with Graves’ orbitopathy. Thyroid 2011; 21: 279-283
    Google Scholar
  • 29 Carella C, Mazziotti G, Sorvillo F, Piscopo M, Cioffi M, Pilla P, Nersita R, Iorio S, Amato G, Braverman LE, Roti E. Serum thyrotropin receptor antibodies concentrations in patients with Graves’ disease before, at the end of methimazole treatment, and after drug withdrawal: evidence that the activity of thyrotropin receptor antibody and/or thyroid response modify during the observation period. Thyroid 2006; 16: 295-302
    CrossrefPubMedGoogle Scholar
  • 30 Dralle H, Sekulla C. Morbidity after subtotal and total thyroidectomy in patients with Graves’ disease: the basis for decision-making regarding surgical indication and extent of resection. Zeitsch Arzt Fortbild Qualitatssicher 2004; 98 (Suppl. 05) 45-53
    PubMedGoogle Scholar
  • 31 Alesina PF, Singaporewalla RM, Eckstein A, Lahner H, Walz MK. Is minimally invasive, video-assisted thyroidectomy feasible in Graves’ disease?. Surgery 149: 556-560
    PubMedGoogle Scholar
  • 32 Menconi F, Marino M, Pinchera A, Rocchi R, Mazzi B, Nardi M, Bartalena L, Marcocci C. Effects of total thyroid ablation versus near-total thyroidectomy alone on mild to moderate Graves’ orbitopathy treated with intravenous glucocorticoids. J Clin Endocrinol Metab 2007; 92: 1653-1658
    CrossrefPubMedGoogle Scholar
  • 33 Moleti M, Violi MA, Montanini D, Trombetta C, Di Bella B, Sturniolo G, Presti S, Alibrandi A, Campenni A, Baldari S, Trimarchi F, Vermiglio F. Radioiodine ablation of postsurgical thyroid remnants after treatment with recombinant human TSH (rhTSH) in patients with moderate-to-severe graves’ orbitopathy (GO): a prospective, randomized, single-blind clinical trial. J Clin Endocrinol Metab 2014; 99: 1783-1789
    CrossrefPubMedGoogle Scholar
  • 34 Leo M, Marcocci C, Pinchera A, Nardi M, Megna L, Rocchi R, Latrofa F, Altea MA, Mazzi B, Sisti E, Profilo MA, Marino M. Outcome of Graves’ orbitopathy after total thyroid ablation and glucocorticoid treatment: follow-up of a randomized clinical trial. J Clin Endocrinol Metab 2012; 97: E44-E48
    CrossrefPubMedGoogle Scholar
  • 35 Bottazzo GF, Pujol-Borrell R, Hanafusa T, Feldmann M. Role of aberrant HLA-DR expression and antigen presentation in induction of endocrine autoimmunity. Lancet 1983; 2: 1115-1119
    PubMedGoogle Scholar
  • 36 Metcalfe RA, McIntosh RS, Marelli-Berg F, Lombardi G, Lechler R, Weetman AP. Detection of CD40 on human thyroid follicular cells: analysis of expression and function. J Clin Endocrinol Metab 1998; 83: 1268-1274
    PubMedGoogle Scholar
  • 37 Wang FM, Chen XM, Hao C, Tang HB, Shen Q, Xu XY, Xu XG, Qian H, Li Q, Yao P, Li JH, Chen L. Costimulatory molecule CD40 expression in thyroid tissue of Graves’ disease patients and its immune pathogenetic significance. Zhong yi xue za zhi 2013; 93: 764-767
    PubMedGoogle Scholar
  • 38 Cohen SB, Weetman AP. Activated interstitial and intraepithelial thyroid lymphocytes in autoimmune thyroid disease. Acta Endocrinol 1988; 119: 161-166
    PubMedGoogle Scholar
  • 39 Quadbeck B, Eckstein AK, Tews S, Walz M, Hoermann R, Mann K, Gieseler R. Maturation of thyroidal dendritic cells in Graves’ disease. Scand J Immunol 2002; 55: 612-620
    CrossrefPubMedGoogle Scholar
  • 40 Gianoukakis AG, Douglas RS, King CS, Cruikshank WW, Smith TJ. Immunoglobulin G from patients with Graves’ disease induces interleukin-16 and RANTES expression in cultured human thyrocytes: a putative mechanism for T-cell infiltration of the thyroid in autoimmune disease. Endocrinology 2006; 147: 1941-1949
    CrossrefPubMedGoogle Scholar
  • 41 Laurberg P, Wallin G, Tallstedt L, Abraham-Nordling M, Lundell G, Torring O. TSH-receptor autoimmunity in Graves’ disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study. Eur J Endocrinol 2008; 158: 69-75
    Google Scholar
  • 42 Takamura Y, Nakano K, Uruno T, Ito Y, Miya A, Kobayashi K, Yokozawa T, Matsuzuka F, Kuma K, Miyauchi A. Changes in serum TSH receptor antibody (TRAb) values in patients with Graves’ disease after total or subtotal thyroidectomy. Endocr J 2003; 50: 595-601
    CrossrefPubMedGoogle Scholar
  • 43 Montani V, Shong M, Taniguchi SI, Suzuki K, Giuliani C, Napolitano G, Saito J, Saji M, Fiorentino B, Reimold AM, Singer DS, Kohn LD. Regulation of major histocompatibility class II gene expression in FRTL-5 thyrocytes: opposite effects of interferon and methimazole. Endocrinology 1998; 139: 290-302
    CrossrefPubMedGoogle Scholar
  • 44 Wang P, Sun SH, Silver PB, Chan CC, Agarwal RK, Wiggert B, Kohn LD, Jamieson Jr. GA, Caspi RR. Methimazole protects from experimental autoimmune uveitis (EAU) by inhibiting antigen presenting cell function and reducing antigen priming. J Leuk Biol 2003; 73: 57-64
    CrossrefPubMedGoogle Scholar
  • 45 Eckstein AK, Plicht M, Lax H, Neuhauser M, Mann K, Lederbogen S, Heckmann C, Esser J, Morgenthaler NG. Thyrotropin receptor autoantibodies are independent risk factors for Graves’ ophthalmopathy and help to predict severity and outcome of the disease. J Clin Endocrinol Metab 2006; 91: 3464-3470
    Google Scholar
  • 46 Morshed SA, Latif R, Davies TF. Characterization of thyrotropin receptor antibody-induced signaling cascades. Endocrinology 2009; 150: 519-529
    Google Scholar
  • 47 Morshed SA, Davies TF. Graves’ Disease Mechanisms: The Role of Stimulating, Blocking, and Cleavage Region TSH Receptor Antibodies. Horm Metab Res 2015; 47: 727-734
    Google Scholar
  • 48 Zhang L, Grennan-Jones F, Lane C, Rees DA, Dayan CM, Ludgate M. Adipose tissue depot-specific differences in the regulation of hyaluronan production of relevance to Graves’ orbitopathy. J Clin Endocrinol Metab 2012; 97: 653-662
    CrossrefPubMedGoogle Scholar