The aftermath of orbital radiotherapy for graves' ophthalmopathy.
OBJECTIVE
To determine whether long-term improvement could be observed after orbital radiotherapy for Graves' disease; in addition, to evaluate ancillary treatments needed for those who have received radiotherapy, to search for late-emerging adverse consequences of radiotherapy, and to relate orbital changes to serum levels of thyroid-stimulating immunoglobulin (TSI).


METHODS
Three-year follow-up of noncomparative interventional case series.


METHODS
Forty-two patients.


METHODS
All patients had received orbital radiotherapy within 6 months of study entry. Twelve months after study entry, patients were free to select any additional treatment for their ophthalmopathy.


METHODS
Need for surgery, steroid therapy, volume of extraocular muscles and fat, proptosis, area of diplopia fields and range of extraocular muscle motion, volume changes after decompression and correlations of eye findings with serum TSI levels, retinal status.


RESULTS
Half of the patients elected to have a surgical procedure on their eyes or orbits. Among patients who were not decompressed, we found only slight improvement in some of the main outcome measures. TSI did not positively correlate with baseline status or with any observed change in major outcome measures. After orbital decompression, the volumes of both muscle and fat increase, but bony orbital volume increases more and proptosis diminishes. Retinal microvascular abnormalities consistent with radiation retinopathy developed de novo in five eyes of three patients within 3 years of radiation therapy.


CONCLUSIONS
In this 3-year uncontrolled follow-up phase, limited evidence for a clinically significant improvement was observed, which may be the result of treatment or of natural remission. In either case, the changes are of little clinical significance. Because it is neither effective nor innocuous, radiotherapy does not seem to be indicated for treatment of mild to moderate ophthalmopathy.
Gorman
Colum A
CA
Department of Medicine, Mayo Clinic, Rochester, Minnesota. Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Garrity
James A
JA
Fatourechi
Vahab
V
Bahn
Rebecca S
RS
Petersen
Ivy A
IA
Stafford
Scott L
SL
Earle
John D
JD
Forbes
Glenn S
GS
Kline
Robert W
RW
Buettner
Helmut
H
Robertson
Dennis M
DM
Bergstralh
Erik J
EJ
Offord
Kenneth P
KP
Rademacher
Diana M
DM
Stanley
Nancy M
NM
Bartley
George B
GB
D000328:Adult; D000368:Aged; D019299:Decompression, Surgical; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating / Q000097:blood; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000528:radiation effects* / Q000601:surgery; D013974:Thyroxine / Q000097:blood; D016896:Treatment Outcome; D014284:Triiodothyronine / Q000097:blood
D018828:Immunoglobulins, Thyroid-Stimulating; D014284:Triiodothyronine; D013974:Thyroxine