source: The Journal of Clinical Endocrinology and Metabolism

year: 2014

authors: Moleti M, Violi MA, Montanini D, Trombetta C, Di Bella B, Sturniolo G, Presti S, Alibrandi A, Campennì A, Baldari S, Trimarchi F, Vermiglio F

Context:
Recent evidence suggests thyroidectomy (Tx) followed by radioiodine remnant ablation to be beneficial to Graves’ orbitopathy (GO) patients.

Objective:
The aim of the study was to evaluate the effect of 131I thyroid ablation after recombinant human TSH stimulation in patients with moderate-to-severe GO.

Design, Patients, and Interventions:
The study was prospective, randomized, and single-blind, and it included 40 consecutive patients with moderate-to-severe GO randomized into: 1) a Tx-radioactive iodine (RAI) group (20 subjects who underwent total-Tx and 131I ablation after recombinant human TSH stimulation); and 2) a Tx group (20 subjects who underwent total-Tx alone).

Outcome Measures:
The overall GO outcome 12 months after Tx/radioiodine ablation was the main measure.

Results:
GO evaluation at the end of iv glucocorticoids showed eye disease to be improved in 65% of the Tx-RAI group and 60% of the Tx group patients. At 6 and 12 months, no further changes in the GO outcome could be observed in the Tx-RAI group. Conversely, five patients from the Tx group exhibited a deterioration in GO. At 12 months, GO was found to be improved in 70% of the Tx-RAI and 20% of the Tx group patients, the latter being found to be stable (55%) or worse (25%) than at baseline evaluation. At 12 months, GO was found to be inactive in a significantly higher percentage of patients in the Tx-RAI than in the Tx group (75 vs 30%; P < .01).

Conclusions:
Postoperative radioiodine ablation proved more effective than Tx alone in inducing earlier and steadier GO improvement in patients with moderate-to-severe GO treated with iv glucocorticoids over a 24-month follow-up period.

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