An Evaluation of Plasma Exchange for Graves' Ophthalmopathy

Kelly, William F.; Longson, Donald; Smithard, DG; Fawcitt, Richard; Wensley, R. T.; Noble, J L; Keeley, Jane

doi:10.1111/j.1365-2265.1983.tb02878.x

Cited by 57 publications

(21 citation statements)

References 16 publications

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“…Favorable results were also reported by Berlin et al (154), who observed a reduction of the OI in 9 (69%) and of subjective symptoms in 10 (77%) of 13 patients; azathioprine was concomitantly administered to 8 patients, and 2 patients needed further sessions of plasmapheresis. In contrast, unfavorable effects of plasmapheresis were reported in other series (155,156). In summary, plasmapheresis provided conflicting results, since both favorable effects and treatment failures were reported.…”

Section: Plasmapheresismentioning

confidence: 41%

Management of Graves' Ophthalmopathy: Reality and Perspectives

Bartalena¹

2000

Endocrine Reviews

299

351

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Graves' ophthalmopathy is an debilitating disease impairing the quality of life of affected individuals. Despite recent progress in the understanding of its pathogenesis, treatment is often not satisfactory. In mild cases, local therapeutic measures (artificial tears and ointments, sunglasses, nocturnal taping of the eyes, prisms) can control symptoms and signs. In severe forms of the disease (3-5%), aggressive measures are required. If the disease is active, high-dose glucocorticoids and/or orbital radiotherapy, or orbital decompression represent the mainstay of treatment. If the disease is severe but inactive, orbital decompression is preferred. Novel treatments such as somatostatin analogs or intravenous immunoglobulins are under evaluation. Rehabilitative (extraocular muscle or eyelid) surgery is often needed after treatment and inactivation of eye disease. Correction of both hyper-and hypothyroidism is crucial for the ophthalmopathy. Antithyroid drugs and thyroidectomy do not influence the course of the ophthalmopathy, whereas radioiodine treatment may cause the progression of preexisting ophthalmopathy, especially in smokers. The exacerbation, however, is prevented by glucocorticoids. In addition, thyroid ablation may prove beneficial for the ophthalmopathy in view of the pathogenetic model relating eye disease to autoimmune reactions directed against antigens shared by the thyroid and the orbit.

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Section: Plasmapheresismentioning

confidence: 41%

Management of Graves' Ophthalmopathy: Reality and Perspectives

Bartalena¹

2000

Endocrine Reviews

299

351

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“…The most significant effects were on soft tissue involvement, proptosis, intraocular pressure, and visual acuity [228]. In contrast to these, unfavorable effects of plasmapheresis have been reported [229,230]. Trials involving plasmapheresis provided conflicting results.…”

Section: Plasmapheresismentioning

confidence: 99%

Complications of Hyperthyroidism

Sayin¹,

Ertek²,

Cesur³

2014

Thyroid Disorders - Focus on Hyperthyroidism

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“…Cyclophosphamide has proved beneficial in patients with optic neuropathy, diplopia and chemosis (Bigos et al 1979, Wall et al 1979, and this agent would seem worthy of further investigation. Plasma exchange was recently evaluated in 18 patients and found to be of no benefit (Kelly et al 1983). This is an important finding in terms of the aetiology, since it provides indirect evidence that serum autoantibodies are unlikely to be involved in the production of the eye disease.…”

Section: Treatmentmentioning

confidence: 99%

Ocular Manifestations of Graves' Disease: A Review

Weetman¹,

McGregor²,

Hall³

1984

J R Soc Med

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Graves' ophthalmopathy is probably the most difficult management problem for the thyroidologist. This review aims to highlight recent advances in our knowledge of the condition in the fields of diagnosis, aetiology and treatment, but it will become apparent that much remains to be understood of the aetiology of Graves' ophthalmopathy which consequently impairs optimal management of the condition. DiagnosisThe presence of characteristic eye signs, namely periorbital oedema, chemosis, injection of the sclerae, exophthalmos, lid retraction and ophthalmoplegia in any combination, together with hyperthyroidism, present no difficulty in diagnosis. Problems may arise however if the patient is not and has not been thyrotoxic, in which case the condition is termed ophthalmic Graves' disease (OGD); in this subgroup the signs are often unilateral, raising the possibility of a retro-ocular space-occupying lesion in the differential diagnosis. Biochemical investigationsIn OGD thyroid hormone levels (total or free) by definition are not elevated. However, it should be remembered that patients with Hashimoto's thyroiditis may have eye signs which are also covered by the term OGD (Ormston et al. 1973), so that T3 and T4 may be either normal or low in OGD and occasionally minor elevations of free T3 levels are seen in OGD (Teng & Yeo 1977). In a sequential study of 27 euthyroid patients with OGD followed for three years, one became hyperthyroid and 7 hypothyroid (Teng & Yeo 1977) and therefore long-term follow up of euthyroid OGD patients is important.The TSH response to TRH is abnormal in about half of the patients with OGD, being impaired or absent in 40% and exaggerated in 7% (Teng & Yeo 1977). As expected, a close correlation was also found in this study between T3-induced suppression of thyroidal radioactive iodine uptake and the results of the TRH test, so that the latter alone will suffice as a diagnostic test. Immunological investigationsThyroglobulin and microsomal antibodies occur in about 75% of patients with OGD, reflecting in part the presence of Hashimoto's thyroiditis in some of these subjects. Such antibodies are readily measured and are valuable markers for OGD. TSH receptor antibodies, measured by their displacement of radiolabelled TSH from its thyroid receptor in vitro, are positive in 40% of OGD patients ) and thyroid-stimulating antibodies, measured by the thyroid slice-cAMP release assay, were found in all 6 patients tested with OGD and an impaired TSH response to TRH; 4 subjects with OGD and a normal TRH test did not have such antibodies (Zakarija et al. 1980). The use of such assays adds little to the diagnostic information more easily available from the TRH test and tests for conventional thyroid autoantibodies.

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An Evaluation of Plasma Exchange for Graves' Ophthalmopathy

Cited by 57 publications

References 16 publications

Management of Graves' Ophthalmopathy: Reality and Perspectives

Management of Graves' Ophthalmopathy: Reality and Perspectives

Complications of Hyperthyroidism

Ocular Manifestations of Graves' Disease: A Review

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