The effect of subtotal thyroidectomy on Graves' ophthalmopathy

Nineteen unselected patients undergoing subtotal thyroidectomy (STT) for Graves' disease were submitted to thorough ophthalmologic assessment before and after (mean, 10 mo) thyroid surgery. All clinical examinations were performed by the same observer and findings were scored according to the American Thyroid Association (“NOSPECS”) classification. Orbital computed tomography (CT) scans were performed in all patients prior to surgery and again at follow‐up if the initial scan was abnormal or if there was evidence of clinical deterioration; all CT scans were viewed by the same individual. There was evidence of infiltrative ophthalmopathy at some stage in the course of observation in 17 (89%) of the 19 patients. No predictable ocular response to STT was apparent. Ophthalmic status was noted to improve in 6 patients, to remain unchanged in 7 patients, and to progressively deteriorate in 6 patients. This unpredictable pattern was seen irrespective of the severity of preexisting ocular involvement. The absence of any consistent or predictable ocular response to STT strongly suggests that thyroidectomy does not influence the natural course of Graves' ophthalmopathy. We believe that the presence of evolving or stable ophthalmopathy, even if severe, should not be regarded as a contraindication to STT in Graves' disease.