Total thyroidectomy for the treatment of hyperthyroidism in patients with ophthalmopathy.

Total thyroidectomy was performed in 54 cases of Graves' ophthalmopathy from 1971 to August 2000. There were no surgical complications except for one case of mild hypocalcemia. The patients' postoperative lives were not disturbed. Ocular symptoms and signs were much improved after total thyroidectomy in most cases, but the ocular protrusion was reduced 0.9 mm on average (from 20.6 to 19.7 mm), and this improvement was not statistically significant. However, removal of the thyroid tissue was not complete in some cases in this series and the residual thyroid tissue may continuously support the progress of ophthalmopathy. Surgical influences on Graves' ophthalmopathy were compared between total and subtotal thyroidectomy in each of 50 gender- and age-matched cases from the same period. Average protrusion was reduced 0.9 mm after total thyroidectomy, but was increased 0.5 mm after subtotal thyroidectomy. In conclusion, total thyroidectomy can be performed as safely as subtotal thyroidectomy and is more effective for Graves' ophthalmopathy than subtotal thyroidectomy. However, this procedure would not be expected to completely inactivate aggressive ophthalmopathy, even if all thyroid tissue was removed. In severe cases, orbital decompression, corrective eye muscle, and lid surgery are necessary.