Introduction: Graves ophthalmopathy (GO) is an orbital autoimmune disorder closely linked to thyroid autoimmunity, mainly Graves disease. After an initial progressive inflammatory period (active phase), GO stabilizes and eventually subsides (inactive phase). Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patients quality of life. Patients with active, mild disease generally benefit from local therapies and selenium, while patients with moderate to severe active disease usually require the addition of intravenous glucocorticoid (GCs) therapy. If there is an inadequate response to GC therapy, several second line therapies have been used, including orbital radiotherapy and biological agents.
Method: We performed a retrospective review of patients assessed in the thyroid GO clinical board of the Parc Taulí Hospital between 2016 and 2018; we selected those with moderate and severe active GO that received treatment with intravenous GCs and, in the absence of response, other second or third line therapies. The activity of the disease was assessed according to the clinical activity score (CAS).
Results: Of 53 patients assessed, 17 had moderate to severe active GO (CAS ≥3) and were considered candidates for receiving treatment with intravenous GCs. The underlying thyroid disorder was Graves disease in 16 patients and Hashimoto thyroiditis in 1 patient; thyroid stimulating immunoglobulin was positive in all patients. The age range of the patients was 4172: 10 women and 7 men. A satisfactory CAS reduction was observed with GCs in 11 patients, but 6 patients did not respond, so we initiated a second and third line therapy. 5 patients received radiotherapy, being effective in 3; 3 patients received rituximab, being effective in 2; 1 patient received tocilizumab, obtaining remission. It is important to note that the treatments carried out were only effective in controlling the inflammatory symptoms (assessed according to the CAS), but the outcomes in terms of improvement of diplopia and proptosis were poor, with 6 patients undergoing strabismus surgery and 4 patients undergoing not emergent orbital decompression.
Conclusion: In our cohort the rate of response of the different treatments was 64.7% with intravenous GCs, 60% with radiotherapy, 66% with rituximab and 1 of 1 with tocilizumab.
18 - 21 May 2019
European Society of Endocrinology