Endocrine Abstracts

Objectives: Orbital radiotherapy (OR) is the most commonly used second-line treatment for the severe forms of Graves’ orbitopathy (GO). The aim of our study was to assess the changes in the therapeutic response, ocular manifestations of GO and quality of life (QoL) during the first year after OR.

Methods: The study involved 26 consecutive patients with active moderate-to-severe GO indicated for OR, 18 females, mean age 57±12.5. At baseline all patients underwent comprehensive ocular examination and thyroid hormone and antibody testing. Then, OR was performed with a total dose of 20 Gy, divided into 10 sessions of 2 Gy each, with concomitant intake of low-dose glucocorticoids. Therapeutic response and individual ocular manifestations were evaluated at the 1st, 3rd, 6th and 12th months after OR, and QoL – at the 3rd, 6th and 12th months by a disease-specific questionnaire.

Results: At month 1, therapeutic response (full or partial) was observed in 61.6% of the patients. During the follow-up the proportion of the full-responders gradually increased to 57.5% at the 12th month, while that of non-responders gradually decreased, reaching 11.5% at the 12th month. All individual ocular manifestations improved significantly 1-3 months after OR. At the 1st month, the proportion of patients with improvement in diplopia (34.6%) and proptosis (30.8%) was the highest, followed by visual acuity (26.9%). At 3rd and 6th month, most patients had improvement in visual acuity, subjective symptoms, diplopia and CAS. At the 12th month, the largest proportion of patients had an improvement in diplopia, followed by soft tissue involvement, subjective complaints and CAS. QoL related to visual functioning improved significantly at the 3rd month and at each subsequent time point of the follow-up, QoL related to appearance increased significantly at the 6th month with additional significant improvement at the 12th month.

Conclusions: OR is a highly effective treatment for active moderate-to-severe GO. The initial effect on the therapeutic response and individual ocular parameters was evident as soon as 1-3 months after the procedure. QoL improved gradually during the follow-up period.