Graves ophthalmopathy (GO) in the majority of cases is modest and self-limiting and no treatment is required beside local measures and prompt control of thyroid dysfunction. A minority of patients (35%) have severe GO which warrants aggressive treatment to arrest further progression and eventually achieve regression of existing ocular signs and symptoms. Treatment of severe GO is a complex therapeutic challenge and available treatments provide unsatisfactory results in about one third of patients. Glucocorticoids (GC), orbital radiotherapy (RT), or a combination of both, are most frequently used. GC are more effective using the iv route than through the oral route, but particular attention should be paid to the possible liver toxicity of IV GC. The efficacy and safety of RT has been confirmed by recent randomized clinical trials. At variance with previous promising results, recent studies have shown that currently available somatostatin analogs are not very effective. Cytokine antagonists, currently used in other autoimmune diseases, have shown positive results in a small series of GO patients. Antioxidants might also be used, at least in mild form of GO. The possibility that total thyroid ablation might be beneficial is under investigation. Finally, particular attention should be paid to correction of risk factors involved in GO progression, such as cigarette smoking, thyroid dysfunction, radioiodine therapy.
01 - 05 Apr 2006
European Society of Endocrinology