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ABSTRACT: Background
The optimal therapeutic choice for Graves' hyperthyroidism in the presence of moderate-severe Graves' orbitopathy (GO) remains controversial.Objectives
We aimed to compare GO course in patients with moderate-severe GO treated with early total thyroidectomy (TTx) versus antithyroid drug (ATD) regimens, in a prospective, randomized manner.Methods
Forty-two patients with moderate-severe GO were enrolled. A total of 4.5 g of pulse corticosteroids were given intravenously to all patients before randomization. Patients in the first group were given TTx, whereas patients in the second group were treated with ATDs. TSH was kept between 0.4 and 1 mIU/l. The clinical course of GO was evaluated with proptosis, lid aperture, clinical activity score (CAS), and diplopia.Results
Eighteen and 24 patients were randomized to the TTx and ATD groups, respectively. Thyroid autoantibodies decreased significantly, and there were significant improvements in proptosis, lid aperture, and CAS in the TTx group. While in the ATD group the decrement in thyroid autoantibodies was not significant, there were significant improvements in proptosis and CAS. When the TTx group was compared with the ATD group, anti-TPO, anti-Tg, and TSH-receptor antibodies were significantly decreased in the TTx group (p < 0.01), but there was no significant difference with respect to proptosis, lid aperture, CAS, and diplopia between the two groups during a median (min.-max.) follow-up period of 60 months (36-72).Conclusion
Although no definitive conclusions could be drawn from the study, mainly due to limited power, early TTx and the ATD treatment regimens, followed by intravenous pulse corticosteroid therapy, seemed to be equally effective on the course of GO in this relatively small group of patients with moderate-severe GO during a median (min.-max.) follow-up period of 60 months (36-72).
SUBMITTER: Erdogan MF
PROVIDER: S-EPMC4949371 | biostudies-literature | 2016 Jul
REPOSITORIES: biostudies-literature
Erdoğan Murat Faik MF Demir Özgür Ö Ersoy Reyhan Ünlü RÜ Gül Kamile K Aydoğan Berna İmge Bİ Üç Ziynet Alphan ZA Mete Türkan T Ertek Sibel S Ünlütürk Uğur U Çakır Bekir B Aral Yalçın Y Güler Serdar S Güllü Sevim S Çorapçıoğlu Demet D Dağdelen Selçuk S Erdoğan Gürbüz G
European thyroid journal 20160426 2
<h4>Background</h4>The optimal therapeutic choice for Graves' hyperthyroidism in the presence of moderate-severe Graves' orbitopathy (GO) remains controversial.<h4>Objectives</h4>We aimed to compare GO course in patients with moderate-severe GO treated with early total thyroidectomy (TTx) versus antithyroid drug (ATD) regimens, in a prospective, randomized manner.<h4>Methods</h4>Forty-two patients with moderate-severe GO were enrolled. A total of 4.5 g of pulse corticosteroids were given intrave ...[more]