Immunosuppressive Therapy for the Eye Changes of Graves' Disease

Burrow, Gerard N.; Mitchell, Malcolm S.; Howard, Rufus O.; Morrow, Lewis B.

doi:10.1210/jcem-31-3-307

Cited by 52 publications

(10 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4,[13][14][15][16] They are used in view of their anti-inflammatory and immunosuppressive actions. 17 Most commonly, GC has been used through the oral or local (retrobulbar or subconjunctival) routes, 16 but locally administered GC is not as effective as systemic GC treatment. 17 On the other hand, oral GC therapy requires the use of high doses of prednisolone (60-100 mg/day, or equivalent) for prolonged periods of time (usually several months).…”

Section: Discussionmentioning

confidence: 99%

“…17 Most commonly, GC has been used through the oral or local (retrobulbar or subconjunctival) routes, 16 but locally administered GC is not as effective as systemic GC treatment. 17 On the other hand, oral GC therapy requires the use of high doses of prednisolone (60-100 mg/day, or equivalent) for prolonged periods of time (usually several months). 8 The use of radiotherapy in conjunction with GC treatment has been shown to prevent the rebound of the inflammatory manifestations that are often seen after GC treatment alone.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Factors associated with outcome after combined steroid and orbital radiotherapy on Graves’ ophthalmopathy

et al. 2013

View full text Add to dashboard Cite

In order to seek possible confounding factors in relation to clinical responsiveness to high-dose intravenous steroid pulse therapy and orbital irradiation followed by oral steroids in the treatment of thyroid-associated ophthalmopathy (TAO), we reviewed the medical records of 53 admitted patients (22 men and 31 women out of a total pool of 167 patients who had diagnosis of TAO). To assess the improvement TAO, we employed proptosis as an objective index and followed up longitudinally. The final ratios of improvement in the left and right eyes respectively were 71.0% and 64.5%. Significant difference in the therapeutic effect on proptosis was found between male and female at the end of observation. The decrease in proptosis was significantly greater in female patients than in male patients (P<0.05). Among patients' background characteristics, smoking status and body mass index did not relate to the severity of the eye disease but rather to its improvement (right: P=0.18, left: P<0.05). These results suggest that the combined steroid and radiotherapy followed by oral steroid therapy should be optimized to obtain higher effectiveness.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors associated with outcome after combined steroid and orbital radiotherapy on Graves’ ophthalmopathy

et al. 2013

View full text Add to dashboard Cite

show abstract

“…In a study by Burrow et al (1970) of the use of azathioprine in the treatment of Graves' ophthal¬ mopathy, in which no benefit accrued despite profound immunosuppression, a remarkable case is described of a patient who was rendered hypo¬ thyroid by excessive treatment with propylthiouracil but who promptly became thyrotoxic once more when azathioprine was added to the treat¬ ment to achieve immunosuppression. One theore¬ tical possibility is that the immunosuppressive treatment allows the development of one clone of lymphocytes which are capable of producing ab¬ normal thyroid stimulators.…”

Section: Discussionmentioning

confidence: 99%

The development of thyrotoxicosis (Graves' disease) during immunosuppression for autoimmune haemolytic anaemia

Thomson

Wilson

Walker

1986

Acta Endocrinologica

View full text Add to dashboard Cite

show abstract

“…Immunosuppression Azathioprine was found to be ineffective in 5 patients with chronic ophthalmopathy, but none had optic neuropathy and in 4 the changes were longstanding (Burrow et al 1970). 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.…”

Section: Treatmentmentioning

confidence: 99%

Ocular Manifestations of Graves' Disease: A Review

Weetman¹,

McGregor²,

Hall³

1984

J R Soc Med

View full text Add to dashboard Cite

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.

show abstract

Immunosuppressive Therapy for the Eye Changes of Graves' Disease

Cited by 52 publications

References 0 publications

Factors associated with outcome after combined steroid and orbital radiotherapy on Graves’ ophthalmopathy

Factors associated with outcome after combined steroid and orbital radiotherapy on Graves’ ophthalmopathy

The development of thyrotoxicosis (Graves' disease) during immunosuppression for autoimmune haemolytic anaemia

Ocular Manifestations of Graves' Disease: A Review

Contact Info

Product

Resources

About