Treatment of Progressive Malignant Exophthalmos by Total Thyroidectomy

Kirmse, L.; Schemmel, K.; Lahrtz, Hg.; Waschulzik, G.; Müller, Werner A.; Uthgenannt, H

doi:10.1530/acta.0.072s024

Cited by 2 publications

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“…At the opposite end of the spectrum of opinion, several authors have expressed the viewpoint that total thyroidectomy improves ophthalmopathy [9][10][11] and have gone so far as to recommend this operation as definitive therapy for advanced ophthalmopathy. Others, however, have not been able to reproduce these results [20], and thyroidectomy has not gained general support in the literature as treatment for ophthalmopathy.…”

Section: Discussionmentioning

confidence: 99%

The effect of subtotal thyroidectomy on Graves' ophthalmopathy

Levitt¹,

Edis²,

Agnello³

et al. 1988

World j. surg.

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Nineteen unselected patients undergoing subtotal thyroidectomy (STT) for Graves' disease were submitted to thorough ophthalmologic assessment before and after (mean, 10 mo) thyroid surgery. All clinical examinations were performed by the same observer and findings were scored according to the American Thyroid Association (“NOSPECS”) classification. Orbital computed tomography (CT) scans were performed in all patients prior to surgery and again at follow‐up if the initial scan was abnormal or if there was evidence of clinical deterioration; all CT scans were viewed by the same individual. There was evidence of infiltrative ophthalmopathy at some stage in the course of observation in 17 (89%) of the 19 patients. No predictable ocular response to STT was apparent. Ophthalmic status was noted to improve in 6 patients, to remain unchanged in 7 patients, and to progressively deteriorate in 6 patients. This unpredictable pattern was seen irrespective of the severity of preexisting ocular involvement. The absence of any consistent or predictable ocular response to STT strongly suggests that thyroidectomy does not influence the natural course of Graves' ophthalmopathy. We believe that the presence of evolving or stable ophthalmopathy, even if severe, should not be regarded as a contraindication to STT in Graves' disease.

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Section: Discussionmentioning

confidence: 99%

The effect of subtotal thyroidectomy on Graves' ophthalmopathy

Levitt¹,

Edis²,

Agnello³

et al. 1988

World j. surg.

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Total thyroid ablation: A prerequisite to orbital decompression for graves disease ophthalmopathy

White

1974

The Laryngoscope

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The fundamental cause of the ophthalmopathy of Graves disease is not known. This has precluded a specific means of prevention. Surgical, medical and radiation means of palliation are presented. Our data indicates that total ablation of all active thyroid tissue prevents initiation of ophthalmopathy as well as accomplishing permanent control of progression of already present ophthalmopathy in Graves disease. Improved surgical techniques of orbital decompression are described and recognized as giving excellent palliation of the ophthalmopathy. These extensive procedures do not take into consideration, have no influence on the underlying cause of, nor do they have any effect upon the progression of the ophthalmopathy. Presented are patients with Graves disease ophthalmopathy subjected to orbital decompression who experienced only temporary relief of their ophthalmopathy. Subsequent to the decompression there was progression of the ophthalmopathy with increasing chemosis, diplopia, and exophthalmos. Thyroid scans demonstrated residual active disease in all instances. The temporary benefits of orbital decompression in Graves disease ophthalmopathy are indisputable. It may be vision saving, but also must be considered palliative. A plea is made that all active thyroid tissue be totally ablated before consideration is given to orbital decompression as a therapeutic or palliative procedure, except as an emergency vision saving procedure as in “impending blindness” in Graves disease ophthalmopathy.

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Treatment of Progressive Malignant Exophthalmos by Total Thyroidectomy

Cited by 2 publications

References 0 publications

The effect of subtotal thyroidectomy on Graves' ophthalmopathy

The effect of subtotal thyroidectomy on Graves' ophthalmopathy

Total thyroid ablation: A prerequisite to orbital decompression for graves disease ophthalmopathy

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