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Abstract
Treatment of diffuse toxic goiter with autoimmune ophthalmopathy is one of the problems of modern endocrinology, because of the complex mechanism of the pathogenesis of disease and its severe course, which in some cases leads to disability of patients. One of methods for treating this pathology is surgery, namely thyroidectomy, which provides the rapid elimination not only thyrotoxicosis but also a «target» for anti-thyroid antibodies. Subsequently, glucocorticoid pulse therapy is used to treat autoimmune ophthalmopathy, as was recommended by EUGOGO 2016. However, the choice of the optimal time to start pulse therapy after thyroidectomy is not noted a significant improvement in the clinical course of ophthalmopathy in 14.3% patients. In the whole group, the activity of ophthalmopathy (by CAS) also decreased, and no significant changes in the size of the exophthalmos, thickness of the chorioretinal
complex and retrobulbar fiber were revealed. Conclusions. After surgery (in the volume of thyroidectomy) for diffuse toxic goiter with autoimmune ophthalmopathy, the concentration level of TSHR-Abs was significantly decreased after 6 months and its minimum level was reached after 36 months. The clinical course of ophthalmopathy, which is manifested in the disappearance of spontaneous retrobulbar pain, periorbital edema, conjunctival hyperemia and hemosis, was significantly improved in 14.3% patients. It is advisable to start pulse therapy with glucocorticoids in 6 months after thyroidectomy, when the state of euthyroidism is reached on the background of levothyroxine replacement therapy and there is a probable decrease in TSHR-Abs.
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