Treatment of mild, moderate-to-severe and very severe Graves鈥?orbitopathy

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• 作者：Claudio Marcocci ; MD ; ^{Claudio.marcocci@med.unipi.it} (Professor of Endocrinology) ; Michele Marinò ; MD¹ ; ^{Michele.marino@med.unipi.it} (Assistant Professor of Endocrinology)
• 关键词：glucocorticoids ; orbital radiotherapy ; orbital surgery ; dysthyroid optic neuropathy
• 刊名：Best Practice Research Clinical Endocrinology Metabolism
• 出版年：2012
• 期刊代码：34_1521690X
• 类别：med
• 出版时间：June, 2012
• 卷：26
• 期：3
• 页码：325-337
• 文件大小：516 K

摘要

Treatment of Graves鈥?orbitopathy (GO) is better performed through a multidisciplinary approach. Euthyroidism should be promptly restored. Antithyroid drug and thyroidectomy are not disease-modifying treatments, whereas radioiodine may be associated with worsening of GO. This risk is eliminated by glucocorticoid prophylaxis. Treatments for GO differ depending on its severity and activity. Mild forms should be treated with local measures. In addition a course of selenium may be beneficial. Glucocorticoids (oral or intravenous) represent the main treatment of moderate-to-severe GO, the intravenous route being more effective. Weekly pulses of methylprednisolone are used and the cumulative dose should not exceed 8聽g. Severe adverse events have been reported, particularly with higher doses. Orbital radiotherapy can be used either alone or associated with glucocorticoids. In very severe sight-threatening GO high dose intravenous glucocorticoid should be the initial treatment, orbital decompression being considered in nonresponding patients. Rehabilitative surgery should be deferred until GO becomes inactive.