The outcome of thyroidectomy in the management of thyroid-associated ophthalmopathy in Graves’ disease

Background: Graves’ ophthalmopathy is caused by autoimmune reactions against antigens shared by thyroid and orbital tissues, sustained by intrathyroidal autoreactive T-lymphocytes infiltrating the orbit. The role of surgery in treating ophthalmopathy, as well as the extent of resection, remains debated. Antithyroid drugs may improve or not affect ophthalmopathy, while radioiodine may worsen it unless glucocorticoids are given.Aims: To evaluate the effect of thyroidectomy on the progression of ophthalmopathy, particularly exophthalmos, and compare outcomes among total, subtotal, and near-total thyroidectomies. Additionally, compare outcomes in preoperatively optimized versus directly operated cases.Methods: A prospective, two-center multi disciplinary team study enrolled 22 patients with thyrotoxic goiters and mild-to-moderate exophthalmos. Preoperative evaluation was done using NOSPECS classification, MRI for extraocular muscle diameters, and Hertel’s exophthalmometer. Reassessment occurred at 3 and 8 months postoperatively.Results: 78% of patients experienced significant improvement in ophthalmopathy. Near-total thyroidectomy was superior to total thyroidectomy in reducing permanent hypoparathyroidism, with no significant difference in recurrence. No major complications occurred. No prognostic factors influencing ophthalmopathy were identified, possibly due to small sample size. Patients were mostly young, female, and nonsmokers.Conclusion: Thyroidectomy significantly improves thyroid-associated ophthalmopathy and eliminates recurrence risk associated with subtotal thyroidectomy, with near-total thyroidectomy providing a favorable balance of outcomes.