Reactivation of Graves’ ophthalmopathy post-thyroidectomy for Graves’ disease
Author: Stephanie J Chiu
Base Hospital / Institution: Royal Hallamshire Hospital / Sheffield Teaching Hospitals
ePoster presentation
Abstract ID: 24-336
Purpose
To determine whether peri-operative glucocorticoid use during total thyroidectomy for Graves’ disease prevents early post-operative reactivation of Graves’ ophthalmopathy (GO).
Methods
A retrospective cohort study covering 5 years, studying patients undergoing total thyroidectomy for Graves’ disease. Patients were divided into 3 groups. Group A (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.
Results
Group A (n=14): At least one had post-operative reactivation of GO. Group B (n=10): None had post-operative reactivation of GO. Group C (n=10): Five patients had post-operative reactivation of GO. Two of these were within 90 days, 2 within 120 days, and 1 at 179 days of thyroid surgery. CAS scores could only be compared for Groups B and C. Post-operative worsening of GO was associated with CAS >0 (p=0.0325) and TSH <0.02 mIU/L (p=0.0136).
Conclusion
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 that this group requires longer post-operative steroid or alternative immunosuppression post-operatively.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Christine A | Putri | Royal Hallamshire Hospital / Sheffield Teaching Hospitals |
| Saba P | Balasubramanian | Royal Hallamshire Hospital / Sheffield Teaching Hospitals |
| Amit | Allahabadia | Royal Hallamshire Hospital / Sheffield Teaching Hospitals |
| Sachin M | Salvi | Royal Hallamshire Hospital / Sheffield Teaching Hospitals |
