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. |
