Efficacy of corticosteroids and external beam radiation in the management of moderate to severe thyroid eye disease.
Thyroid Eye Disease (TED, Graves ophthalmopathy, thyroid ophthalmopathy) is the most common cause of orbital inflammation and proptosis in adults. There is no agreement on its management although corticosteroids and external beam orbital radiation (XRT) have traditionally been believed to provide benefit in active inflammation. Our review of the published literature in English disclosed an overall corticosteroid-mediated treatment response of 66.9% in a total of 834 treated patients who had moderate or severe TED. Intravenous corticosteroids used in repeated weekly pulses were more effective (overall favorable response = 74.6%, n = 177) and had fewer side effects than daily oral corticosteroids (overall favorable response = 55.5%, n = 265). A combination of corticosteroid and radiation therapy seemed to be more effective than corticosteroids alone. Our conclusions are tempered by a notable lack of standardization within and between study designs, treatment protocols, and outcome measures. Accordingly, the North American Neuro-Ophthalmology Society (NANOS), American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and the Orbital Society, in conjunction with Neuro-Ophthalmology Research and Development Consortium (NORDIC), will investigate the design and funding of a multi-center controlled trial.
Zoumalan
Christopher I
CI
Department of Ophthalmology, Stanford University School of Medicine, 900 Blake Wilbur Drive, Stanford, CA 94305, USA. zoumalan@stanford.edu
Cockerham
Kimberly P
KP
Turbin
Roger E
RE
Volpe
Nicholas J
NJ
Kazim
Michael
M
Douglas
Raymond S
RS
Feldon
Steven E
SE
D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D002986:Clinical Trials as Topic / Q000379:methods / Q000592:standards; D018450:Disease Progression; D005123:Eye / Q000187:drug effects* / Q000503:physiopathology / Q000528:radiation effects*; D049970:Graves Ophthalmopathy / Q000188:drug therapy* / Q000503:physiopathology / Q000532:radiotherapy*; D006801:Humans; D007275:Injections, Intravenous; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones