A retrospective study on the efficacy of total absorbed orbital doses of 12, 16 and 20 Gy combined with systemic steroid treatment in patients with Graves’ orbitopathy

Johnson, Kristian; Wittig, Andrea; Loesch, Christian; Esser, Joachim; Sauerwein, W.; Eckstein, Anja

doi:10.1007/s00417-009-1214-3

Cited by 38 publications

(28 citation statements)

References 26 publications

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“…There are no large RCTs comparing the advantage of this combined treatment over IV glucocorticosteroids alone [28,30,31]. As reported in a randomised study, lower orbital doses of 12 Gy were sufficient in reducing soft tissue changes, and higher doses were required in patients with ocular motility impairment [32]. It is generally accepted that orbital irradiation should be considered in patients with The efficacy of GO treatment after previous ATD or 131-I therapy Agnieszka Jagiełło-Korzeniowska et al…”

Section: Discussionmentioning

confidence: 99%

Wcześniejsze leczenie choroby Gravesa lekami tyreostatycznymi lub radiojodem nie wpływa na skuteczność leczenia immunosupresyjnego orbitopatii tarczycowej

Jagiełło-Korzeniowska¹,

Sokołowski

Krzentowska-Korek³

et al. 2016

Endokrynologia Polska

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Introduction: We studied the efficacy of immunosuppressive treatment of GO in a group of patients who had been treated with antithyroid drugs (the ATD group) and in another group that had undergone radioiodine therapy (the 131-I group). Material and methods: A total of 214 patients with exacerbation of GO were studied; the ATD group consisting of 168 patients, and the 131-I group consisting of 46 patients. All patients were treated with methylprednisolone IV pulses (total dose 8.0 g) followed by orbital irradiation (20 Gy in 10 fractions). CAS and IO indices, TSH, fT4, and TRAb levels were evaluated prior to, and 1, 6, and 12 months after treatment.

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Section: Discussionmentioning

confidence: 99%

Wcześniejsze leczenie choroby Gravesa lekami tyreostatycznymi lub radiojodem nie wpływa na skuteczność leczenia immunosupresyjnego orbitopatii tarczycowej

Jagiełło-Korzeniowska¹,

Sokołowski

Krzentowska-Korek³

et al. 2016

Endokrynologia Polska

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“…It is possible that orbital radiotherapy may also potentiate the effects of intravenous GCs, but evidence on this specific issue is currently missing [81]. A cumulative dose of 20 Gy per orbit fractionated in 10 daily doses given over a 2-week period is commonly used [1,2], but an alternative regimen of 1 Gy per week over a 20-week period was shown to be equally effective and better tolerated [82,83]. Mild and transient exacerbation of ocular symptoms induced by irradiation may occur, but can be controlled by concomitant low-dose oral GC administration [81].…”

Section: Recommendationsmentioning

confidence: 99%

The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

et al. 2016

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Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment.

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“…Furthermore, bilateral orbital irradiation was performed in 12 patients in the past without achieving sufficient remission. Because in most cases pretreatment was not coordinated by our centre, both orbital irradiation and steroid therapy were administered at variable treatment and dosing regimes 19. A history of smoking was present in 87% of patients.…”

Section: Resultsmentioning

confidence: 99%

Course of pattern-reversed visual evoked cortical potentials in 30 eyes after bony orbital decompression in dysthyroid optic neuropathy

Lipski

Eckstein²,

Esser³

et al. 2010

British Journal of Ophthalmology

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Aim: To investigate optic nerve function using the pattern-reversed visual evoked potentials (VECP) before and after bony orbital decompression in dysthyroid optic neuropathy (DON) due to Grave´s disease.Methods: A total of 30 eyes of 15 patients (n=14 female) were observed over 30 ± 13 months after bony 3-wall orbital decompression. We examined visual acuity (VA), VECP P100 amplitudes and latencies as well as proptosis using Hertel´s exophthalmometry.

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A retrospective study on the efficacy of total absorbed orbital doses of 12, 16 and 20 Gy combined with systemic steroid treatment in patients with Graves’ orbitopathy

Abstract: If the aim of retrobulbar irradiation is primarily to reduce soft-tissue signs, lower doses are sufficient. If a patient also suffers from dysmotility, doses exceeding 12 Gy may be more effective.

Cited by 38 publications

References 26 publications

Wcześniejsze leczenie choroby Gravesa lekami tyreostatycznymi lub radiojodem nie wpływa na skuteczność leczenia immunosupresyjnego orbitopatii tarczycowej

Wcześniejsze leczenie choroby Gravesa lekami tyreostatycznymi lub radiojodem nie wpływa na skuteczność leczenia immunosupresyjnego orbitopatii tarczycowej

The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

Course of pattern-reversed visual evoked cortical potentials in 30 eyes after bony orbital decompression in dysthyroid optic neuropathy

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