Int J Thyroidol.  2019 Nov;12(2):91-96. 10.11106/ijt.2019.12.2.91.

Treatment of Graves' Ophthalmopathy

Affiliations
  • 1Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea. lk1246@cau.ac.kr

Abstract

Graves' ophthalmopathy (GO) is an autoimmune disease associated with orbital inflammation and fibrosis which can result in lid retraction, soft tissue swelling, and proptosis. Treatment should rely on a thorough assessment of the activity and severity of GO. Control of risk factors for GO progression and topical treatments for dry eye are recommended for all patients. In mild GO, a careful observation is usually sufficient. In moderate-to-severe and active GO, high-dose intravenous glucocorticoids can be considered an initial treatment. The most common schedule for intravenous glucocorticoids is a cumulative dose of 4.5 g of methylprednisolone, divided into 12 weekly infusions (6 weekly infusions of 0.5 g, followed by 6 weekly infusions of 0.25 g). Orbital radiation has been shown to be an effective secondary treatment in patients with active GO unresponsive to intravenous glucocorticoids. Rehabilitative surgery is needed in patients with GO when the disease is associated with a significant impact on quality of life or visual function after the disease has been inactive for at least 6 months.

Keyword

Graves' ophthalmopathy; Activity; Severity; Steroid; Orbital decompression

MeSH Terms

Appointments and Schedules
Autoimmune Diseases
Exophthalmos
Fibrosis
Glucocorticoids
Humans
Inflammation
Methylprednisolone
Orbit
Quality of Life
Risk Factors
Glucocorticoids
Methylprednisolone

Figure

  • Fig. 1. Management of Graves’ ophthalmopathy based on recommendation of European Group on Graves’ Orbitopathy (EUGOGO).


Reference

1). Bartley GB. The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota. Trans Am Ophthalmol Soc. 1994; 92:477–588.
2). Smith TJ, Bahn RS, Gorman CA, Cheavens M. Stimulation of glycosaminoglycan accumulation by interferon gamma in cultured human retroocular fibroblasts. J Clin Endocrinol Metab. 1991; 72(5):1169–71.
Article
3). Smith TJ, Hoa N. Immunoglobulins from patients with Graves' disease induce hyaluronan synthesis in their orbital fibroblasts through the self-antigen, insulin-like growth factor-I receptor. J Clin Endocrinol Metab. 2004; 89(10):5076–80.
Article
4). Wiersinga WM, Bartalena L. Epidemiology and prevention of Graves' ophthalmopathy. Thyroid. 2002; 12(10):855–60.
Article
5). Mourits MP, Prummel MF, Wiersinga WM, Koornneef L. Clinical activity score as a guide in the management of patients with Graves' ophthalmopathy. Clin Endocrinol (Oxf). 1997; 47(1):9–14.
Article
6). Bartalena L, Baldeschi L, Dickinson A, Eckstein A, Kendall-Taylor P, Marcocci C, et al. Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol. 2008; 158(3):273–85.
Article
7). Bartalena L, Baldeschi L, Dickinson AJ, Eckstein A, Kendall-Taylor P, Marcocci C, et al. Consensus statement of the European group on Graves' orbitopathy (EUGOGO) on management of Graves' orbitopathy. Thyroid. 2008; 18(3):333–46.
Article
8). Karlsson F, Dahlberg P, Jansson R, Westermark K, Enoksson P. Importance of TSH receptor activation in the development of severe endocrine ophthalmopathy. Acta endocrinologica. Supplementum. 1989; 121(2):132–41.
9). Prummel MF, Wiersinga WM, Mourits MP, Koornneef L, Berghout A, Van der Gaag R. Amelioration of eye changes of Graves' ophthalmopathy by achieving euthyroidism. Acta Endocrinologica. 1989; 121(Supple 2):185–189.
10). Bartalena L, Marcocci C, Bogazzi F, Manetti L, Tanda ML, Dell'Unto E, et al. Relation between therapy for hyperthyroidism and the course of Graves' ophthalmopathy. N Engl J Med. 1998; 338(2):73–8.
Article
11). Li HX, Xiang N, Hu WK, Jiao XL. Relation between therapy options for Graves' disease and the course of Graves' ophthalmopathy: a systematic review and metaanalysis. J Endocrinol Invest. 2016; 39(11):1225–33.
Article
12). Acharya SH, Avenell A, Philip S, Burr J, Bevan JS, Abraham P. Radioiodine therapy (RAI) for Graves' disease (GD) and the effect on ophthalmopathy: a systematic review. Clin Endocrinol (Oxf). 2008; 69(6):943–50.
Article
13). Lai A, Sassi L, Compri E, Marino F, Sivelli P, Piantanida E, et al. Lower dose prednisone prevents radioiodine-associated exacerbation of initially mild or absent graves' orbitopathy: a retrospective cohort study. J Clin Endocrinol Metab. 2010; 95(3):1333–7.
Article
14). Shiber S, Stiebel-Kalish H, Shimon I, Grossman A, Robenshtok E. Glucocorticoid regimens for prevention of Graves' ophthalmopathy progression following radioiodine treatment: systematic review and metaanalysis. Thyroid. 2014; 24(10):1515–23.
Article
15). Prummel MF, Wiersinga WM. Smoking and risk of Graves' disease. JAMA. 1993; 269(4):479–82.
Article
16). Eckstein A, Quadbeck B, Mueller G, Rettenmeier AW, Hoermann R, Mann K, et al. Impact of smoking on the response to treatment of thyroid associated ophthalmopathy. Br J Ophthalmol. 2003; 87(6):773–6.
Article
17). Traisk F, Tallstedt L, Abraham-Nordling M, Andersson T, Berg G, Calissendorff J, et al. Thyroid-associated ophthalmopathy after treatment for Graves' hyperthyroidism with antithyroid drugs or iodine-131. J Clin Endocrinol Metab. 2009; 94(10):3700–7.
18). Tanda ML, Piantanida E, Liparulo L, Veronesi G, Lai A, Sassi L, et al. Prevalence and natural history of Graves' orbitopathy in a large series of patients with newly diagnosed graves' hyperthyroidism seen at a single center. J Clin Endocrinol Metab. 2013; 98(4):1443–9.
Article
19). Gurdal C, Sarac O, Genc I, Kirimlioglu H, Takmaz T, Can I. Ocular surface and dry eye in Graves' disease. Curr Eye Res. 2011; 36(1):8–13.
20). Kocabeyoglu S, Mocan MC, Cevik Y, Irkec M. Ocular Surface Alterations and In Vivo Confocal Microscopic Features of Corneas in Patients With Newly Diagnosed Graves' Disease. Cornea. 2015; 34(7):745–9.
Article
21). Rayman MP. Selenium and human health. Lancet. 2012; 379(9822):1256–68.
Article
22). Marcocci C, Kahaly GJ, Krassas GE, Bartalena L, Prummel M, Stahl M, et al. Selenium and the course of mild Graves' orbitopathy. N Engl J Med. 2011; 364(20):1920–31.
Article
23). Jang JY, Cho YY, Kim TH, Kim SW, Chung JH. Selenium concentration in Korean patients with thyroid disease: a preliminary report. Int J Thyroidol. 2016; 9(2):152–8.
Article
24). Zang S, Kahaly GJ. Steroids and the immune response in Graves orbitopathy. Immunol Endocr Metab Agents Med. 2011; 11(2):90–8.
Article
25). Stiebel-Kalish H, Robenshtok E, Hasanreisoglu M, Ezrachi D, Shimon I, Leibovici L. Treatment modalities for Graves' ophthalmopathy: systematic review and metaanalysis. J Clin Endocrinol Metab. 2009; 94(8):2708–16.
Article
26). Zhu W, Ye L, Shen L, Jiao Q, Huang F, Han R, et al. A prospective, randomized trial of intravenous glucocorticoids therapy with different protocols for patients with graves' ophthalmopathy. J Clin Endocrinol Metab. 2014; 99(6):1999–2007.
Article
27). Bartalena L, Krassas GE, Wiersinga W, Marcocci C, Salvi M, Daumerie C, et al. Efficacy and safety of three different cumulative doses of intravenous methylprednisolone for moderate to severe and active Graves' orbitopathy. J Clin Endocrinol Metab. 2012; 97(12):4454–63.
Article
28). Kahaly GJ, Pitz S, Hommel G, Dittmar M. Randomized, single blind trial of intravenous versus oral steroid monotherapy in Graves' orbitopathy. J Clin Endocrinol Metab. 2005; 90(9):5234–40.
29). Zang S, Ponto KA, Pitz S, Kahaly GJ. Dose of intravenous steroids and therapy outcome in Graves' orbitopathy. J Endocrinol Invest. 2011; 34(11):876–80.
Article
30). Marcocci C, Watt T, Altea MA, Rasmussen AK, Feldt- Rasmussen U, Orgiazzi J, et al. Fatal and non-fatal adverse events of glucocorticoid therapy for Graves' orbitopathy: a questionnaire survey among members of the European Thyroid Association. Eur J Endocrinol. 2012; 166(2):247–53.
Article
31). Riedl M, Kolbe E, Kampmann E, Kramer I, Kahaly GJ. Prospectively recorded and MedDRA-coded safety data of intravenous methylprednisolone therapy in Graves' orbitopathy. J Endocrinol Invest. 2015; 38(2):177–82.
Article
32). Sandler HM, Rubenstein JH, Fowble BL, Sergott RC, Savino PJ, Bosley TM. Results of radiotherapy for thyroid ophthalmopathy. Int J Radiat Oncol Biol Phys. 1989; 17(4):823–7.
Article
33). Kazim M, Trokel S, Moore S. Treatment of acute Graves orbitopathy. Ophthalmology. 1991; 98(9):1443–8.
Article
34). Bartalena L, Pinchera A, Marcocci C. Management of Graves' ophthalmopathy: reality and perspectives. Endocr Rev. 2000; 21(2):168–99.
Article
35). Marcocci C, Bartalena L, Rocchi R, Marino M, Menconi F, Morabito E, et al. Long-term safety of orbital radiotherapy for Graves' ophthalmopathy. J Clin Endocrinol Metab. 2003; 88(8):3561–6.
Article
36). Salvi M, Vannucchi G, Curro N, Campi I, Covelli D, Dazzi D, et al. Efficacy of B-cell targeted therapy with rituximab in patients with active moderate to severe Graves' orbitopathy: a randomized controlled study. J Clin Endocrinol Metab. 2015; 100(2):422–31.
Article
37). Stan MN, Garrity JA, Carranza Leon BG, Prabin T, Bradley EA, Bahn RS. Randomized controlled trial of rituximab in patients with Graves' orbitopathy. J Clin Endocrinol Metab. 2015; 100(2):432–41.
Article
38). Shen WC, Lee CH, Loh EW, Hsieh AT, Chen L, Tam KW. Efficacy and Safety of Rituximab for the Treatment of Graves' Orbitopathy: A Meta-analysis of Randomized Controlled Trials. Pharmacotherapy. 2018; 38(5):503–10.
Article
39). Smith TJ, Kahaly GJ, Ezra DG, Fleming JC, Dailey RA, Tang RA, et al. Teprotumumab for Thyroid-Associated Ophthalmopathy. N Engl J Med. 2017; 376(18):1748–61.
Article
40). Bartalena L, Baldeschi L, Boboridis K, Eckstein A, Kahaly GJ, Marcocci C, et al. The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy. Eur Thyroid J. 2016; 5(1):9–26.
Article
41). Curro N, Covelli D, Vannucchi G, Campi I, Pirola G, Simonetta S, et al. Therapeutic outcomes of high-dose intravenous steroids in the treatment of dysthyroid optic neuropathy. Thyroid. 2014; 24(5):897–905.
Article
42). Wiersinga WM, Kahaly GJ. Graves' orbitopathy: a multidisci-plinary approach-questions and answers. 3rd revised and expanded edition. Basel; New York: Karger. 2017.
43). Huh J, Lee JK. Change in quality of life after orbital decompression surgery in patients with dysthyroid ophthalmopathy. J Korean Ophthalmol Soc. 2016; 57(10):1514–20.
Article
44). Choi SU, Kim KW, Lee JK. Surgical outcomes of balanced deep lateral and medial orbital wall decompression in Korean population: clinical and computed tomography-based analysis. Korean J Ophthalmol. 2016; 30(2):85–91.
Article
45). Lim KS, Lee JK. Evaluation of stereotactic navigation during orbital decompression in thyroid-associated orbitopathy patients. J Korean Ophthalmol Soc. 2014; 55(3):337–42.
Article
46). Eckstein A, Esser J. Surgical management of extraocular muscle dysfunction in patients with GO. Bahn RS, editor. Graves' disease: a comprehensive guide for clinicians. New York: Springer;2015. p. 287–99.
Article
47). Chee E, Chee SP. Subconjunctival injection of triamcinolone in the treatment of lid retraction of patients with thyroid eye disease: a case series. Eye (Lond). 2008; 22(2):311–5.
Article
Full Text Links
  • IJT
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr