[Management of Graves' ophthalmopathy].
Graves's ophthalmopathy, the commonest extrathyroidal manifestation of Graves' disease is an autoimmune disorder of the orbit. Restoration of thyroid dysfunction, lubricant eye drops and smoking cessation is important. Clinical activity and disease severity determine specific treatment. Referral to specialist centres is urgent in sight-threatning optic neuropathy. Intravenous methylprednisolone is first-line therapy for clinically active disease. Retrobulbar irradiation may help in persistant ocular muscle inflammation. Prompt orbital decompression is warranted for sight-threatning neuropathy not responding to high-dose methylprednisolone. Decompression is otherwise performed in the chronic phase, before possible eye-muscle and eyelid surgery. Rituximab is a promising immunomodulating drug for resistant clinically active cases.
HYKS:n endokrinologian klinikka, PL 340, 00290 Helsinki.
Camilla
C
Schalin-Jäntti
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D049970:Graves Ophthalmopathy / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007262:Infusions, Intravenous; D008775:Methylprednisolone / Q000008:administration & dosage*; D009901:Optic Nerve Diseases / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D009985:Orthopedics; D000069283:Rituximab
D000893:Anti-Inflammatory Agents; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab; D008775:Methylprednisolone