ABSTRACT
BACKGROUND: The relative merit of surgery in the treatment of Graves' ophthalmopathy as well as the extent of surgical resection are still matters of debate. This study aimed at reporting an assessment of the impact of near-total thyroidectomy on the course of ophthalmopathy including exophthalmos. METHODS: A total of 20 patients with thyrotoxic goiters who were suffering from mild to moderate exophthalmos were enrolled in this prospective study. Preoperative evaluation of ophthalmopathy was accomplished through the NOSPECS classification, magnetic resonance imaging (MRI) for measuring the extraocular muscle diameters, and measurement of the exophthalmos using Hertel's exophthalmometer. Ophthalmopathy including exophthalmos was reevaluated 6 months after operation using the same parameters. RESULTS: Clinical activity evaluation, exophthalmometry, and extraocular muscles measurement by MRI revealed that most of the patients experienced improvement of their ophthalmopathy (65%). This improvement was statistically significant. In addition, no major postoperative complications were observed. However, the study, unlike a number of reported retrospective ones, failed to specify any statistically significant prognostic factors affecting the course of ophthalmopathy; this may have been due to the limited number of patients. In addition, all of the patients were of relatively young age and thyrotoxic, and most were female and nonsmoking. CONCLUSIONS: In addition to the fact that near-total thyroidectomy adds the advantages of total thyroidectomy (no recurrence) to those of subtotal thyroidectomy (low incidence of temporary and permanent hypoparathyroidism), it has a significant positive impact on thyroid-associated orbitopathy.