Autori: Ursu HI, Galoiu S ,Podia CI ,Purice M , Stanescu B Goldstein A , Alexandrescu D
Editorial: Eur Thyroid J , Vol 2Vol. 2, Suppl. 1, 2013.
A long term follow – up of thyrotoxic patients treated surgically
is required not only for early detection of hypothyroid patients with
poor compliance with treatment, but also for revealing late postoperative
hyperthyroidism. Regarding the prevalence of postoperative hyperthyroidism,
two previous studies found that 16% relapsed after 20 years (Kalk WJ, 1978)
and 19% of post – thyroidectomy thyrotoxicosis occurred 20 -50 years after
surgical therapy (Hamburger JI, 1976).
Objectives: Detection of late onset of Graves´ thyrotoxicosis after subtotal
Methods: Our study group consisted of 6 patients (5F,1M) with late recurrences
of Graves hyperthyroidism (mean age: 58.1 yrs; age range: 52–73 yrs);
they were operated (subtotal thyroidectomy) in the surgical unit of the Institute
of Endocrinology from Bucharest. Diagnosis of recurrent Graves hyperthyroidism
was based on clinical features and laboratory data (suppressed serum
TSH, high serum FT4 or T4, high serum T3); T3 – thyrotoxicosis was diagnosed
in one patient (16.6%).
Results: The interval between surgical therapy and recurrent hyperthyroidism
range from 17 yrs to 41 yrs (average interval: 23.8 yrs). Thyroid peroxidase
autoantibodies were increased in two cases without proptosis, being
an argument for autoimmune thyrotoxicosis. In two patients (33.3%), recurrence
of hyperthyroidism was associated with thyrotoxic atrial fibrillation.
Half of the patients (3 cases) were treated with radioiodine and the other half
(3 patients) are euthyroid on therapy with methimazole and will be treated
with radioiodine in the near future.
Conclusions: Radioiodine therapy was not associated with worsening of
Graves ophthalmopathy, because Graves orbitopathy was inactive when radioiodine
was given. Radioiodine therapy is the treatment of choice in patients
with postoperative recurrence of thyrotoxicosis, being safe and effective even
in patients with thyrotoxic heart disease.
Cuvinte cheie: postoperativ hyperthyroidism, recurence