IMPACT OF THE EXTENT OF THYROID RESECTION ON HYPERTHYROIDISM-ASSOCIATED OPHTHALMOPATHY
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Objective: This study was designed to evaluate the impact of the extent of thyroid resection on the degree of hyperthyroidism-associated ophthalmopathy. Patients and Methods: This study included 40 patients with Graves' disease. Patients were randomly allocated in 2 equal groups according to the surgical procedure assigned: total thyroidectomy (Group TT) & subtotal thyroidectomy (Group STT). All patients underwent full ophthalmic examination to determine the degree of exophthalmos using the modified scale system of the American Thyroid Association (ATA Scale) preoperatively and 3-monthly for lyear after surgery. Patients underwent MRI examination of the orbit preoperatively and 12- months postoperatively for evaluation of the surgical outcome. Results: Postoperative (12-months after surgery) exophthalmometer examination revealed improvement of the degree of exophthalmos in 7 patients, worsening in 2 patients and stationary exophthalmos in 31 patients with a non-significant (p>0.05) difference between patients distribution according to ATA scale between both groups. Moreover, postoperative MRI showed no noticeable difference in comparison to preoperative image either as regards the degree of ocular muscle hypertrophy or the crowding of the retrobulbar space, however, some cases showed decreased amount of retrobulbar edema and fatty deposition. Two patients in group STT developed relapse of thyrotoxicosis. There was a non-significant difference (X`1.871, p>0.05) between the frequency of postoperative complications in both groups. Conclusion: It could be concluded that thyroidectomy did not greatly improve the thyroid ophthalmopathy, even some cases got worse and total thyroidectomy is more beneficial to safeguard against relapse of toxicity with minimal morbidity. Keywords: Graves' disease, Ophthalmopathy ,, Total thyroidectomy, Subtotal thyroidectomy.