Development of Thyroid-Associated Ophthalmopathy in Patients Who Underwent Total Thyroidectomy

Abstract

PurposeTo report clinical characteristics of thyroid-associated ophthalmopathy (TAO) in patients who previously underwent total thyroidectomy for thyroid cancer or a benign mass of the thyroid.Materials and MethodsOf the patients who were diagnosed with TAO from March 2008 to March 2012, we performed a retrospective chart review on those who had undergone total thyroidectomy for thyroid cancer or a benign mass of the thyroid before the occurrence of ophthalmopathy.ResultsOf the 206 patients diagnosed with TAO, seven (3.4%) met the inclusion criteria. The mean age of the subjects was 47.4 years, and all were female. Six patients were diagnosed with papillary thyroid cancer, and one was diagnosed with a benign mass. The duration between total thyroidectomy and onset of TAO ranged from 3-120 months (median 48 months). Ophthalmic manifestations varied among cases. Except for the patient who was diagnosed with a benign mass, all patients showed hyperthyroid status and were under Synthroid hormone treatment at the time of TAO development. Five of these six patients had positive levels of thyroid-stimulating hormone (TSH) receptor autoantibodies.ConclusionTAO rarely develops after total thyroidectomy, and the mechanism of TAO occurrence is unclear. However, most patients showed abnormalities in thyroid function and TSH receptor autoantibodies.

De Novo Extra-Thyroidal Manifestations of Graves’ Disease presenting 16 Years after Total Thyroidectomy for Thyroid Cancer

“…Despite having undergone a total thyroidectomy, our patient developed extra-thyroidal manifestations of GD. Although there have been case reports of euthyroid patients without a previous history of hyperthyroidism who developed signs of GO, 11 – 13 our patient presented with a long latency period of 16 years post total thyroidectomy with PTM and GO. There are fewer than 10 cases reported in the literature so far of GD developing after thyroidectomy for nodules or cancer.…”

“…18 There have been previous case reports of GD being diagnosed biochemically following thyroidectomy, with variable latent time to manifestation (3-120 months, median 48 months). 11,[14][15][16][17] It has been postulated that the persistence of even minimal residual thyroid can have a role in maintaining orbit autoimmune phenomena since antigen triggers could originate from minuscule amounts of thyroid tissue left behind. 18,19 In addition, even though evidence suggests that the thyroid gland is a major site of TSH receptor antibody synthesis in GD, other sites of TRAb synthesis should be considered.…”

Time course of Graves’ orbitopathy after total thyroidectomy and radioiodine therapy for thyroid cancer

“…[19,21,22] Moreover, some cases of de novo GO occurrence after TTA for thyroid cancer in patients without GD before RAI are also published. [23–31] Thus, the risk of appearance, aggravation, or improvement of GO in patients with thyroid cancer is unpredicted.…”

Severe radiation thyroiditis after radioactive iodine for treatment of Graves’ disease

“…The goitre size was estimated according to the World Health Organization simplified classification of goitre: (a) small goitre (grade 0), with no palpable or visible goitre; (b) moderate-sized goitre (grade 1), with a mass in the neck that was consistent with an enlarged thyroid that was palpable but not visible when the neck is in the normal position; or (c) large goitre (grade 2), with a swelling in the neck that was visible when the neck was in the normal position and was consistent with an enlarged thyroid when the neck was palpated. (5) At our institution, small goitres generally receive 10-15 mCi of 131 I, moderate-sized goitres receive 15-20 mCi and large goitres receive 20-30 mCi of RAI. Antithyroid drugs (ATDs) are routinely discontinued 4-7 days prior to RAI treatment and restarted after three days at the discretion of the treating nuclear medicine physician.…”