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.

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    • "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]. "
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    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.
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