Orbital radiotherapy for thyroid eye disease

Dolman, Peter J.; Rath, Suryasnata

doi:10.1097/icu.0b013e3283560b2b

Cited by 55 publications

(34 citation statements)

References 38 publications

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“…Whether combination of intravenous glucocorticoids and orbital radiotherapy is associated with a higher response rate compared to intravenous glucocorticoids alone is uncertain [64] and might be worth exploring. Doubts regarding the true efficacy of orbital radiotherapy were raised by a report of the American Academy of Ophthalmology [72] and another recent review [73]. Orbital radiotherapy is certainly not as effective as glucocorticoids.…”

Section: Managementmentioning

confidence: 99%

Graves' Orbitopathy: Imperfect Treatments for a Rare Disease

Bartalena

2013

Eur Thyroid J

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Graves' orbitopathy (GO) is the most frequent and invalidating extrathyroidal expression of Graves' disease. Its incidence and prevalence are, however, low. About three quarters of Graves' patients have no GO at diagnosis, and moderate-to-severe and severe forms represent no more that 5-6% of cases. Progression to severe forms occurs rarely, but it may be caused by risk factors, the most important being smoking and poor control of thyroid dysfunction. Lot of progress has been recently achieved in the understanding of GO pathogenesis, while the disease remains a therapeutic challenge and dilemma. Common treatments for moderate-to-severe and active forms of GO (glucocorticoids and orbital radiotherapy) frequently provide incomplete responses and may be followed by relapse or progression of GO. After the disease has been inactivated by medical treatment, many patients need rehabilitative surgery for residual manifestations (orbital decompression for exophthalmos, squint surgery for extraocular muscle dysfunction, eyelid surgery for eyelid malposition). Novel pharmacological treatments are on the horizon and might target pathogenetic mechanisms of the disease better than glucocorticoids. Clinical evidence concerning their efficacy and safety is presently lacking.

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Section: Managementmentioning

confidence: 99%

Graves' Orbitopathy: Imperfect Treatments for a Rare Disease

Bartalena

2013

Eur Thyroid J

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“…If visual improvement is only transient or incomplete, OR is recommended with a 1-month course of tapering oral prednisone. 43 ' Who May Not Be a Candidate For RT?…”

Section: Safety Of Rtmentioning

confidence: 99%

Radiation Therapy for Orbitopathy of Thyroid Eye Disease

Farach¹,

Carpenter²

2016

International Ophthalmology Clinics

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Thyroid eye disease (TED) or Graves ophthalmopathy is a debilitating autoimmune disorder of the orbit. This disease is closely associated with autoimmune hyperthyroidism, although it may develop in the euthyroid and hypothyroid states. TED affects approximately 16 women and 3 men in every 100,000 per year. 1 Orbital radiotherapy (OR) is a well-established therapy that has been safely utilized in the treatment of TED for over a century, yet high-level randomized evidence supporting its efficacy and clear treatment guidelines are sparse. This article summarizes the existing literature regarding the use of OR in TED and associated outcomes and toxicities. We also discuss emerging treatment techniques and potential future therapeutic strategies. ' BackgroundThe pathogenesis of TED is attributable to an autoimmune interaction between antithyrotropin receptor antibodies and thyrotropin receptors expressed in the orbit. In the diseased state, the thyrotropin receptor is degraded by antigen-presenting cells resulting in the activation of T-helper cells. Plasma cells are then activated through cytokine interactions to secrete autoantibodies directed against the thyrotropin receptor in the orbit. 1 The result is a progressive orbital inflammatory and fibrotic process. This presents clinically with varying degrees of eyelid retraction, lagophthalmos, proptosis, impaired extraocular motility, diplopia, exposure keratopathy, and periorbital edema. Symptoms may be self-limited or progressive and debilitating, persisting for years despite aggressive therapy. In severe cases, sight-threatening corneal ulceration or compressive optic neuropathy may develop.

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“…En un importante estudio retrospectivo se observó que con el uso conjunto de corticoterapia y RT se obtenía una disminución importante del riesgo de desarrollo de neuropatía óptica frente al uso único de corticoterapia 62 . Recientes metaanálisis también avalan dicha eficacia 55,57 . Nivel evidencia i, grado recomendación B.…”

Section: Eficaciaunclassified

“…6. Cuanto más instaurado está el proceso inflamatoriofibrótico y más desarrollada está la orbitopatía, menor es la eficacia de la RT 11,57,58 . Nivel evidencia i, grado recomendación B.…”

Section: Eficaciaunclassified