Retrobulbar irradiation for thyroid-associated orbitopathy: double-blind comparison between 2.4 and 16 Gy

Gerling, Jürgen; Kommerell, Guntram; Henne, Karl; Laubenberger, Jörg; Schulte‐Mönting, Jürgen; Fells, P

doi:10.1016/s0360-3016(02)03795-1

Cited by 57 publications

(33 citation statements)

References 42 publications

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“…A study comparing the efficacy of high- and low-dose radiation (16 Gy versus 2.4 Gy and 20 Gy versus 10 Gy) reported no marked difference in effect and stated that the radiotherapy dose should not exceed 2.4 Gy for TAO. 60 It may take a few weeks for the effect of radiation to become apparent; the effect is temporary and may cause an increase in inflammation. Therefore, steroid therapy should be continued in the first few weeks of treatment.…”

Section: Medical Treatmentmentioning

confidence: 99%

Thyroid-associated Ophthalmopathy

Şahlı¹,

Günduz²

2017

tjo

103

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Thyroid-associated ophthalmopathy is the most frequent extrathyroidal involvement of Graves’ disease but it sometimes occurs in euthyroid or hypothyroid patients. Thyroid-associated ophthalmopathy is an autoimmune disorder, but its pathogenesis is not completely understood. Autoimmunity against putative antigens shared by the thyroid and the orbit plays a role in the pathogenesis of disease. There is an increased volume of extraocular muscles, orbital connective and adipose tissues. Clinical findings of thyroid-associated ophthalmopathy are soft tissue involvement, eyelid retraction, proptosis, compressive optic neuropathy, and restrictive myopathy. To assess the activity of the ophthalmopathy and response to treatment, clinical activity score, which includes manifestations reflecting inflammatory changes, can be used. Supportive approaches can control symptoms and signs in mild cases. In severe active disease, systemic steroid and/or orbital radiotherapy are the main treatments. In inactive disease with proptosis, orbital decompression can be preferred. Miscellaneous treatments such as immunosuppressive drugs, somatostatin analogs, plasmapheresis, intravenous immunoglobulins and anticytokine therapies have been used in patients who are resistant to conventional treatments. Rehabilitative surgeries are often needed after treatment.

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Section: Medical Treatmentmentioning

confidence: 99%

Thyroid-associated Ophthalmopathy

Şahlı¹,

Günduz²

2017

tjo

103

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“…40,41 Orbital irradiation is well tolerated, with only some transient redness of the eyes and hair loss at the temples. Concern about long-term side effects has not been substantiated.…”

Section: Very Severe Graves' Opthalmopathymentioning

confidence: 99%

Management of Graves' ophthalmopathy

Wiersinga

2007

Nat Rev Endocrinol

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Management of Graves' ophthalmopathy is preferably done in a multidisciplinary setting. Smoking is associated with worse disease outcome. (131)I therapy for hyperthyroidism can also worsen ophthalmopathy, especially if administered during active disease or to patients who smoke or have severe hyperthyroidism, or those with high levels of TSH-receptor-binding inhibitory immunoglobulins. Coadministration of steroids and (131)I therapy is recommended for such high-risk patients. (131)I therapy is safe for patients with inactive Graves' ophthalmopathy. Subtotal thyroidectomy and antithyroid drugs show no benefit or harm to eye changes. There is no good evidence that total thyroid ablation has additional benefit. Artificial teardrops, dark glasses and prisms are very helpful. Dysthyroid optic neuropathy is best treated with intravenous pulsed methylprednisolone; if visual functions do not recover, urgent surgical decompression is indicated. A wait-and-see policy is recommended in mild Graves' ophthalmopathy because the natural history of this condition reveals a tendency to resolve spontaneously. Active, moderately severe Graves' ophthalmopathy qualifies for immunosuppression: intravenous pulsed methylprednisolone is more efficacious and has fewer side effects than oral steroids. Once the disease is inactive, rehabilitative surgery has much to offer. Quality of life is seriously limited in patients with Graves' ophthalmopathy, and remains restricted even after all treatments. Consequently, there is an urgent need for improved treatment modalities, and antibody therapy has shown promise in this respect.

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“…Esta vía resultaría activada por las fracciones habituales de 2 Gy/sesión, y sería la causa del edema radioinducido 60,70 . En diversas instituciones se han utilizado esquemas con menores dosis por sesión y una prolongación del tiempo total de tratamiento, con gran eficacia en el control clínico y menor toxicidad respecto al normofraccionamiento 66,71,72 .…”

Section: Discussionunclassified

“…Solo existen 2 trabajos aleatorizados que comparan dosis total (DT). Uno de ellos compara 2,4 frente a 16 Gy a 0,3 y 2 Gy/sesión respectivamente, sin encontrar diferencias significativas entre ambos fraccionamientos 66 . El otro compara 3 ramas de 20 Gy (1 Gy/semanal), 10 Gy (1 Gy/día) y 20 Gy (2 Gy/día), los 2 últimos en 2 semanas.…”

Section: Esquema De Tratamientounclassified