Vnitr Lek 2005, 51(6):650-657

Predictive factors for symptoms of thyroid ophthalmopathy development in patients after either radioiodine therapy or thyroidectomy

Z. Novák^1,*, P. Hrdá^1,2, P. Matucha¹, I. Šterzl^1,2

¹ Endokrinologický ústav, Praha, ředitel doc. MUDr. Vojtěch Hainer, CSc.

² Ústav imunologie a mikrobiologie 1. lékařské fakulty UK a VFN, Praha, přednosta doc. MUDr. Ivan Šterzl, CSc.

The aim of the study was to investigate whether patients with Graves-Basedow thyrotoxicosis developing into endocrine ophthalmopathy of diverse severity after treatment by radioiodine or total thyroidectomy are different in their pre-treatment parameters from Graves-Basedow patients without any signs of ophthalmopathy development. 42 patients were divided into 2 groups: a group of 26 patients treated by radioiodine and a group of 16 patients treated by thyroidectomy. All patients were without symptoms of ophthalmopathy and were examined clinically, on laboratory markers and by ultrasound of the thyroid and of the orbit. The patients were divided according to the orbit response after treatment into three groups: group 1 without symptoms of ophthalmopathy, group 2 with newly arisen symptoms of irritation and signs of ophthalmopathy activation, group 3 patients with diplopia. No difference was found among groups 1-3 of patients treated by radioiodine in the dosis and in the thyroid volume. In patients treated by thyroidectomy higher levels of anti thyroglobulin autoantibodies were found in joined groups 2 + 3 compared to group 1 (p = 0.044). In patients treated by radioiodine higher levels of anti TSH receptor antibodies were found in group 3 compared to the joined groups 1 + 2 (p = 0.033). In all patients (treated by radioiodine and thyroidectomy) were found higher levels of anti thyroglobulin antibodies in joined groups 2 + 3 compared to group 1 (p = 0.019), higher levels of anti TSH receptor antibodies in group 3 compared to joined groups 1 + 2 (p = 0.015) and increased thickness of the eye muscles in group 3 compared to joined groups 1 + 2 (p = 0.013). As predictive marker of ophthalmopathy anti thyroglobulin antibodies were found, elevated levels of anti TSH receptor antibodies and the sum of orbit muscle thickness served also for the prediction of the development of diplopia.

Keywords: Graves-Basedow thyrotoxicosis; endocrine ophthalmopathy; total thyroidectomy; radioiodine; autoantibodies

Received: January 26, 2004; Accepted: October 18, 2004; Published: June 1, 2005  Show citation