Postoperative radioiodine ablation more effective than thyroidectomy alone in Graves' orbitopathy

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Postoperative radioiodine ablation more effective than thyroidectomy alone in Graves' orbitopathy

Moleti M. J Clin Endocrinol Metab. 2014;doi:10.1210/jc.2013-3093.

Recent study results showed greater improvement in Graves’ orbitopathy with the use of radioiodine ablation of post-thyroidectomy remnants after treatment with recombinant human serum thyrotropin.

“Our results indicate that postoperative radioiodine ablation is more effective than thyroidectomy alone in inducing earlier and steadier [Graves’ orbitopathy] improvement,” Mariacarla Moleti, MD, PhD, of the department of clinical and experimental medicine, section of endocrinology, at the University of Messina, Italy, and colleagues wrote.

This prospective, randomized, single blind study included 40 consecutive patients with moderate to severe Graves’ orbitopathy. The patients were randomly assigned to the thyroidectomy plus radioiodine ablation (RAI) group, which included 20 patients who underwent total thyroidectomy and ablation after recombinant human thyrotropin (rhTSH) stimulation, or the control thyroidectomy-only group, which included 20 patients who underwent total thyroidectomy alone. Throughout the study, two masked physicians performed ophthalmological exams in all patients and evaluated and graded in accordance with European Group on Graves’ Orbitopathy (EUGOGO) recommendations.

At 45 days after thyroidectomy or RAI, the evaluation showed no significant changes in Graves’ orbitopathy status in either group. After the delivery of IV glucocorticoids, Graves’ orbitopathy improved in 65% of the thyroidectomy-RAI group and 60% of the thyroidectomy-only group.

At 6 months, Graves’ orbitopathy status did not change in the thyroidectomy-RAI group, but two patients from the thyroidectomy-only group showed a deterioration in Graves’ orbitopathy (P<.05>

At 1 year, Graves’ orbitopathy was improved in 70% of the thyroidectomy-RAI group and 20% of the thyroidectomy-only group; Graves’ orbitopathy was inactive in a significantly higher percentage of patients in the thyroidectomy-RAI group than in the thyroidectomy-only group (75% vs. 30%, P<.01>

“Further studies investigating the overall benefits and risks of this procedure are warranted before any conclusions can be drawn. Nonetheless, the finding that rhTSH in [Graves’ orbitopathy] patients is safe, in our view, indicates rhTSH-aided total thyroid ablation to be an attractive option for patients with [Graves’ orbitopathy] as it prevents the risk of any detrimental ocular effects resulting from [levothyroxine]-withdrawal hypothyroidism,” the researchers wrote.

Disclosure: The researchers report no relevant financial disclosures. This study was partially supported by grants from Ministero dell’Università e della Ricerca Scientifica, Rome, and from Genzyme Europe B.V.