Outcome of Graves' Orbitopathy after Total Thyroid Ablation and Glucocorticoid Treatment: Follow-Up of a Randomized Clinical Trial

Context: In a previous study, we found that total thyroid ablation (thyroidectomy plus I-131) is associated with a better outcome of Graves' orbitopathy (GO) compared with thyroidectomy alone, as observed shortly (9 months) after glucocorticoid (GC) treatment. Objective: The objective of the study was to evaluate the outcome of GO in the same patients of the previous study over a longer period of time. Design: This was a follow-up of a randomized study. Setting: The study was conducted at a referral center. Patients: Fifty-two of 60 original patients with mild to moderate GO participated in the study. Interventions: Patients randomized into thyroidectomy (TX) or total thyroid ablation and treated with GC were reevaluated in 2010, namely 88.0 +/- 17.7 months after GC, having undergone an ophthalmological follow-up in the intermediate period. Main Outcome Measures: The main outcome measures included the following: 1) GO outcome; 2) time to GO best possible outcome and to GO improvement; and 3) additional treatments. Results: GO outcome at the end of the follow-up was similar in the two groups. However, the time required for the best possible outcome to be achieved was longer in the TX group (24 vs. 3 months, P = 0.0436), as was the time required for GO to improve (60 vs. 3 months, P = 0.0344). Additional treatments were given to a similar proportion of patients in each group (TX, 28%, total thyroid ablation, 25.9%), but they affected GO beneficially more often in the TX group (28 vs. 3.7%, P: 0.0412). Conclusions: Compared with thyroidectomy alone, total thyroid ablation allows the achievement of the best possible outcome and an improvement of GO within a shorter period of time. (J Clin Endocrinol Metab 97: E44-E48, 2012)