Document Detail

Combined radiotherapy and medical immunosuppression in the management of thyroid eye disease.
MedLine Citation:
PMID:  9474324     Owner:  NLM     Status:  MEDLINE    
Although systemic steroids or orbital radiotherapy are effective in limiting the inflammatory response in thyroid eye disease (TED), there are reports of over 70% of treated patients requiring subsequent rehabilitative surgery: either orbital decompression or strabismus correction. This study investigated whether combined immunosuppression with primary orbital radiotherapy together with azathioprine and low-dose prednisolone, applied early in the active disease state, was more effective in treating TED. Forty consecutive patients with active TED were recruited. Orbital MRI (STIR sequence) was used to assess disease activity. Median duration of symptoms was 1.0 year. Subjects were treated with bilateral orbital radiotherapy (20 Gy in 10 fractions) and oral prednisolone and azathioprine. Pre- and post-treatment activity was measured clinically, including uniocular field of fixation, Mourits score and total eye score, until TED became inactive off all treatment. Before treatment, 15 subjects had signs of dysthyroid optic neuropathy, 35 had significant motility restriction and 38 had marked soft tissue signs. On average TED became inactive after 1.2 years (SD 0.7) of immunosuppression, and treatment was well tolerated. One patient required subsequent cosmetic orbital decompression, 6 had successful strabismus surgery and 13 required minor cosmetic lid surgery. Compared with previously reported treatment regimes we think that combined orbital radiotherapy and medical immunosuppression is far more effective than either treatment alone in the management of active TED, and led to fewer side effects of high-dose steroids. In particular there was more than a four-fold reduction in the requirement for orbital decompression and strabismus surgery.
K G Claridge; R Ghabrial; G Davis; M Tomlinson; S Goodman; R A Harrad; M J Potts
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Eye (London, England)     Volume:  11 ( Pt 5)     ISSN:  0950-222X     ISO Abbreviation:  Eye (Lond)     Publication Date:  1997  
Date Detail:
Created Date:  1998-02-26     Completed Date:  1998-02-26     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  8703986     Medline TA:  Eye (Lond)     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  717-22     Citation Subset:  IM    
Bristol Eye Hospital, UK.
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MeSH Terms
Azathioprine / therapeutic use
Combined Modality Therapy
Graves Disease / drug therapy*,  radiotherapy*,  surgery
Immunosuppression / methods*
Immunosuppressive Agents / therapeutic use
Middle Aged
Orbit / surgery
Prednisolone / therapeutic use
Strabismus / surgery
Treatment Outcome
Reg. No./Substance:
0/Immunosuppressive Agents; 446-86-6/Azathioprine; 50-24-8/Prednisolone
Comment In:
Eye (Lond). 1997;11 ( Pt 5):581-2   [PMID:  9474301 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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