Research Article
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Published Online: 9 November 2005

Graves' Disease with Moderate–Severe Endocrine Ophthalmopathy–Long Term Results of a Prospective, Randomized Study of Total or Subtotal Thyroid Resection

Publication: Thyroid
Volume 15, Issue Number 10


The optimal thyroid surgery to be performed in patients with Graves' disease and concomitant endocrine ophthalmopathy is a matter of debate. We randomly assigned 44 patients with moderate–severe eye signs in a trial of treatment with subtotal, leaving a small (approximately 2 g) thyroid remnant, or total thyroidectomy. At inclusion, the patients had been treated with antithyroid drugs, and corticosteroids been given to 12 (27%). All received postoperative thyroxine supplementation and were followed for 3 years at regular examinations. The eye disease improved in all cases, and throughout the study, the two groups did not differ with regard to subjective and objective eye symptoms and laboratory findings. At the study start, motility disturbances were present in 8 and 11 of the cases in the subtotal and total resection group and proptosis in 16 and 17, respectively. After 3 years, the corresponding data were 3 and 6 cases with motility defects and 16 and 15 cases with proptosis. Thyrotropin (TSH)-receptor antibody levels gradually fell and became nondetectable in 21 (49%). The surgical complication rate (permanent recurrent laryngeal nerve paresis and permanent hypoparathyroidism) was significantly higher in the total thyroidectomy group.The data indicate that in patients with Graves' disease and active endocrine ophthalmopathy, subtotal thyroidectomy, leaving a small thyroid remnant, will reduce the risk of surgical complications but not the beneficial effect of surgery.

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cover image Thyroid®
Volume 15Issue Number 10October 2005
Pages: 1157 - 1164
PubMed: 16279849


Published online: 9 November 2005
Published in print: October 2005


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J. Järhult
Department of Surgery, Eksjö Hospital, Eksjö, Sweden.
C. Rudberg
Department of Surgery, Västerås Hospital, Västerås, Sweden.
E. Larsson
Department of Ophthalmology, University Hospital, Uppsala.
H. Selvander
Department of Ophthalmology Eksjö Hospital, Eksjö, Sweden.
K. Sjövall
Department of Ophthalmology Västerås Hospital, Västerås, Sweden.
B. Winsa
Department of Medicine, University Hospital, Uppsala, Sweden.
J. Rastad
University Hospital, Uppsala, Sweden.
F.A. Karlsson
Department of Medicine, University Hospital, Uppsala, Sweden.

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