Management of thyroid eye disease.
Thyroid eye disease (TED) is the most frequent extrathyroidal manifestation of Graves' disease. In most instances it is mild and non-progressive, but in 3%-5% of cases it is severe. Non-severe TED requires only supportive measures, such as eye ointments, sunglasses and prisms. By contrast, severe TED requires aggressive treatment, either medical (high-dose glucocorticoids, orbital radiotherapy) or surgical (orbital decompression). The choice of treatment relies on the assessment of both TED severity and activity. Removal of controllable risk factors, especially cigarette smoking, is important to improve the course and the therapeutic outcome. A coordinated approach to the treatment of hyperthyroidism and TED is also required. Novel promising treatments, to be verified in large series of patients, include somatostatin analogues and cytokine antagonists.
Department of Endocrinology, University of Insubria, Ospedale di Circolo, Viale Borri, 57, 21100 Varese, Italy. l.bartalena@libero.it
Luigi
L
Bartalena
Claudio
C
Marcocci
Laura
L
Tanda
Aldo
A
Pinchera
D013956:Antithyroid Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D004172:Diplopia / Q000188:drug therapy / Q000209:etiology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D005135:Eye Protective Devices; D005143:Eyelids / Q000601:surgery; D005938:Glucocorticoids / Q000627:therapeutic use; D006111:Graves Disease / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D015282:Octreotide / Q000627:therapeutic use; D009801:Oculomotor Muscles / Q000601:surgery; D009824:Ointments; D009883:Ophthalmic Solutions; D009901:Optic Nerve Diseases / Q000188:drug therapy / Q000209:etiology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D010456:Peptides, Cyclic / Q000627:therapeutic use; D020795:Photophobia / Q000209:etiology / Q000628:therapy; D010956:Plasmapheresis; D016540:Smoking Cessation; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013965:Thyroidectomy
D013956:Antithyroid Agents; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D007457:Iodine Radioisotopes; D009824:Ointments; D009883:Ophthalmic Solutions; D010456:Peptides, Cyclic; C060347:lanreotide; D013004:Somatostatin; D015282:Octreotide