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Horm Metab Res 2017; 49(10): 739-747
DOI: 10.1055/s-0043-116945
Endocrine Care

Combination Therapy of Intravenous Steroids and Orbital Irradiation is More Effective Than Intravenous Steroids Alone in Patients with Graves’ Orbitopathy

Michael Oeverhaus
1   Department of Ophthalmology, University Hospital Essen (EUGOGO Center Essen), Essen, Germany
,
Tobias Witteler
1   Department of Ophthalmology, University Hospital Essen (EUGOGO Center Essen), Essen, Germany
2   Department of Medical Oncology, Kliniken Essen-Mitte, Essen, Germany
,
Hildegard Lax
3   Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
,
Joachim Esser
1   Department of Ophthalmology, University Hospital Essen (EUGOGO Center Essen), Essen, Germany
,
Dagmar Führer 
4   Department of Endocrinology and Metabolism, University Hospital Essen, (EUGOGO Center Essen) University Duisburg-Essen, Essen, Germany
,
Anja Eckstein
1   Department of Ophthalmology, University Hospital Essen (EUGOGO Center Essen), Essen, Germany
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Abstract

The aim of this study was to evaluate and compare the efficacy of intravenous (iv) glucocorticoids (GCs) with and without orbital radiotherapy (ORT) in a retrospective analysis of patients with active, moderate-to-severe Graves’ orbitopathy (GO). Since diplopia has the strongest impact on quality of life, a careful work up of motility and binocular single vision (BSV) has been performed. The Essen-EUGOGO-Center database (n=3655) was screened for patients with untreated moderate-to-severe, active GO, onset ≤12 months. The inclusion criteria were met by 148 patients (n=76 ivGC, n=72 ivGC + ORT). We analyzed CAS (inactivation: ≤2), NOSPECS, lid-width, proptosis, motility, and field of BSV. To score the overall ophthalmic outcome, a severity-weighted-score (SOS) was compared with an established EUGOGO inflammation-weighted-score (IOS). Cumulative ivGCs dosages and duration of GO did not differ between the groups. Patients with combination therapy had a significantly more severe GO at baseline. Therefore, a subgroup with matched severity was additionally compared. In the IOS, both groups reached similar improvement rates (55.2 vs. 63.9%; p=0.31). However, in the SOS, the rates differed significantly (46.1 vs. 61.1%; p=0.03- unmatched and p=0.03 matched), despite similar rates of inactivation (65.8 vs. 63.8%). Impaired motility improved significantly more often after combination therapy (p=0.01 matched, p=0.004 unmatched). Treatment responders showed only partial improvement (proptosis: 2.5±0.5 mm; motility: 11.3±10.9°). In our retrospective analysis, combination therapy (ivGCs + ORT) was significantly more effective in reduction of severity and should therefore always be considered in moderate-to-severe GO stages, especially in the presence of motility disorders. However, the limited improvement in clinical parameters, despite the promising effect on inactivation of inflammation, has to be outlined to the patients.

Key words

thyroid eye disease - diplopia - glucocorticoid therapy - orbital radiotherapy - motility - GO - TED

Supplementary Material

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  • Supplementary Material


Publication History

Received: 20 April 2017

Accepted: 12 July 2017

Article published online:
18 September 2017

© Georg Thieme Verlag KG
Stuttgart · New York

 

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