Efficacy of Corticosteroids and External Beam Radiation in the Management of Moderate to Severe Thyroid Eye Disease

Department of Ophthalmology, Stanford University School of Medicine, 900 Blake Wilbur Drive, Stanford, CA 94305, USA.
Journal of Neuro-Ophthalmology (Impact Factor: 1.95). 10/2007; 27(3):205-14. DOI: 10.1097/WNO.0b013e31814a5ef8
Source: PubMed


Thyroid Eye Disease (TED, Graves ophthalmopathy, thyroid ophthalmopathy) is the most common cause of orbital inflammation and proptosis in adults. There is no agreement on its management although corticosteroids and external beam orbital radiation (XRT) have traditionally been believed to provide benefit in active inflammation. Our review of the published literature in English disclosed an overall corticosteroid-mediated treatment response of 66.9% in a total of 834 treated patients who had moderate or severe TED. Intravenous corticosteroids used in repeated weekly pulses were more effective (overall favorable response = 74.6%, n = 177) and had fewer side effects than daily oral corticosteroids (overall favorable response = 55.5%, n = 265). A combination of corticosteroid and radiation therapy seemed to be more effective than corticosteroids alone. Our conclusions are tempered by a notable lack of standardization within and between study designs, treatment protocols, and outcome measures. Accordingly, the North American Neuro-Ophthalmology Society (NANOS), American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and the Orbital Society, in conjunction with Neuro-Ophthalmology Research and Development Consortium (NORDIC), will investigate the design and funding of a multi-center controlled trial.

5 Reads
  • Source
    • "Corticosteroids [7] and external beam orbital radiation [8] (XRT) are commonly used agents for TRO, with newer modalities, such as rituximab (RTX), being investigated [9] [10]. Presently, there is inadequate evidence to ascertain whether medical treatment reliably shortens the active phase of TRO, and there is no agreement on the standard therapeutic protocol for the treatment of TRO [11] [12]. For symptomatic patients without sight-threatening disease , orbital decompression is indicated after the active inflammatory phase has passed, and the patient's disease has stabilized [13]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Thyroid-related orbitopathy (TRO) is associated with inflammation, expansion of orbital fat, enlargement of extraocular muscles, and optic neuropathy (ON). We examined the effects of orbital decompression on the inflammatory and congestive signs of TRO in patients who underwent emergent orbital decompression. Methods: This retrospective, consecutive study included patients with ON from TRO who underwent orbital decompression. Pre- and postoperative orbital inflammatory signs in the operated and nonoperated, contralateral eyes were graded with the 10-item clinical activity score (CAS). Results: Thirty-one orbits were included. Postoperatively, 22 patients and 29 orbits had resolution of ON while the remaining 2 patients had improvement in visual acuity. Mean preoperative CAS was 9.5 ± 0.4. At 12 months, postoperative CAS was 2.1 ± 0.6 (P < 0.01) in the operated eye and 3.2 ± 0.5 (P < 0.05) in the nonoperated, contralateral eye. Conclusion: In our series, 94% of orbits had resolution of ON. There was also a statistically significant postoperative reduction in the CAS in both the operated and nonoperated, contralateral eyes. This phenomenon may be due to lowered venous congestion, decreased intraorbital pressure, and diminution in inflammatory factors.
    06/2013; 2013(4):794984. DOI:10.1155/2013/794984
  • [Show abstract] [Hide abstract]
    ABSTRACT: The key to diagnosing hyperthyroidism from a dermatologic perspective is based on having a high index of suspicion that excess thyroid hormone is responsible for the patient's signs and symptoms. As there are no definitive cutaneous manifestations of hyperthyroidism, a careful review of systems may yield important clinical clues to the diagnosis: Is the patient intolerant of heat? Has there been weight loss? Has the patient experienced any palpitations? Have the bowel habits changed? The unique challenge lies in when systemic symptoms are absent or vague, and the skin manifestations are subtle. Should one routinely check a thyroid-stimuating hormone (TSH) level when the only dermatologic finding is onycholysis? Should one obtain a TSH level before administering botulinum toxin for axillary hyperhidrosis with an otherwise unremarkable review of systems? Should you check thyroid function studies for patients presenting with alopecia areata? There are no definitive answers to these questions. Obviously, the yield will be higher in those patients who have several signs and symptoms referable to a hyperthyroid state. It is my opinion that for isolated findings, such as onycholysis or palmoplantar hyperhidrosis, with an unremarkable review of systems, screening for hyperthyroidism is not mandatory. On the other hand, I believe that it is appropriate to check a TSH level in a woman presenting with alopecia, even if there are no associated constitutional symptoms. When patients present with other autoimmune diseases (i.e., chronic idi-opathic urticaria, dermatitis herpetiformis, lichen sclerosus, etc.) in which there is an increased risk for autoimmune thyroid disease, I think it is reasonable to check for thyroid autoantibodies (anti-thryroglobulin, antithyroid peroxidase), especially if there is a positive family history for autoimmune diseases (notably diabetes mellitus or autoimmune thyroid disease). If positive, these patients may be at a greater risk for the development of autoimmune thyroid disease and should be screened periodically (every 3–5 years) with a TSH assay unless clinical circumstances dictate otherwise. In this era of evidence-based medicine, diagnosing hyperthyroidism is still founded on clinical acumen. Fortunately, a clinician's suspicions are easily confirmed or refuted by straightforward laboratory testing. Maintaining an appropriate index of suspicion for hyperthyroidism will allow patients to be diagnosed and treated expediently, thereby greatly increasing their quality of life
    Southern Medical Journal 10/1969; 62(9):1127-30. DOI:10.1007/978-1-84800-187-9_8 · 0.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Online tool wear estimation plays a very critical role in industrial automation for higher productivity and product quality. In addition, appropriate and timely decision for tool change is required in machining systems. Thus, the paper describes the development of an estimation system through integration of two promising technologies, artificial neural networks (ANN) and fuzzy logic. The proposed system consists of five components: (1) data collection, (2) feature extraction, (3) pattern recognition, (4) multi-sensor integration, and (5) tool/work distance compensation. Physical experiments for a metal cutting process are implemented to evaluate the proposed system. The results showed that the proposed system can significantly increase the accuracy of the product profile
    Neural Networks Proceedings, 1998. IEEE World Congress on Computational Intelligence. The 1998 IEEE International Joint Conference on; 06/1998
Show more