Comparison of Early Total Thyroidectomy with Antithyroid Treatment in Patients with Moderate-Severe Graves' Orbitopathy: A Randomized Prospective Trial.

Autor:	Erdoğan MF; Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey., Demir Ö; Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey., Ersoy RÜ; Department of Endocrinology and Metabolic Diseases, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey., Gül K; Department of Endocrinology and Metabolic Diseases, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey., Aydoğan Bİ; Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey., Üç ZA; Department of Endocrinology and Metabolic Diseases, Ankara Training and Research Hospital, Ankara, Turkey., Mete T; Endocrinology and Metabolic Diseases, Ankara Numune Training and Research Hospital, Ankara, Turkey., Ertek S; Department of Endocrinology and Metabolic Diseases, Ufuk University Medical Faculty, Ankara, Turkey., Ünlütürk U; Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey., Çakır B; Department of Endocrinology and Metabolic Diseases, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey., Aral Y; Department of Endocrinology and Metabolic Diseases, Ankara Training and Research Hospital, Ankara, Turkey., Güler S; Endocrinology and Metabolic Diseases, Ankara Numune Training and Research Hospital, Ankara, Turkey., Güllü S; Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey., Çorapçıoğlu D; Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey., Dağdelen S; Department of Endocrinology and Metabolic Diseases, Hacettepe University Medical Faculty, Ankara, Turkey., Erdoğan G; Department of Endocrinology and Metabolic Diseases, Ufuk University Medical Faculty, Ankara, Turkey.
Jazyk:	angličtina
Zdroj:	European thyroid journal [Eur Thyroid J] 2016 Jul; Vol. 5 (2), pp. 106-11. Date of Electronic Publication: 2016 Apr 26.
DOI:	10.1159/000444796
Abstrakt:	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).
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu