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Reactivation of Graves’ ophthalmopathy post-thyroidectomy for Graves’ disease


 
 
 The impact of thyroidectomy for Graves’ disease (GD) on Graves’ ophthalmopathy (GO) is not well understood. It is generally accepted that thyroidectomy does not exacerbate or precipitate GO in the majority. The aim of this study was to evaluate whether prophylactic glucocorticoid use following total thyroidectomy for GD disease prevents early post-operative reactivation of GO.
 
 
 
 A retrospective cohort study covering 5 years, studying patients undergoing total thyroidectomy for GD. Patients were divided into 3 groups. Group A (Clinical Activity Score (CAS) unknown): Patients with symptoms such as dry eyes or signs of inactive GO, as assessed by the Endocrine Surgical team; or patients seen by their local ophthalmologist, but with signs of GO not severe enough to warrant referral to the orbital team (tertiary centre). Group B (CAS=0): Patients with burnt out or no GO, as assessed by the orbital team. Group C (CAS >0): Patients with active GO, as assessed by the Orbital team. All were given prophylactic glucocorticoid cover.
 
 
 
 At least one patient in group A (n=14), none in group B (n=10) and five in group C (n=10) had early post-operative reactivation of Graves’ ophthalmopathy. Post-operative worsening of Graves’ ophthalmopathy was associated with CAS >0 (p=0.0325) and thyroid stimulating hormone <0.02 mIU/L (p=0.0136).
 
 
 
 In those receiving prophylactic steroid, six (17.6%) demonstrated worsening GO. This was associated with a CAS >0 and TSH <0.02 mIU/L, suggesting either optimisation of both factors prior to thyroidectomy or considering a more potent steroid regimen.
