Management of Graves’ ophthalmopathy – 2022 update

Česká verzia

Authors: Jan Jiskra
Authors place of work: 3. interní klinika – klinika endokrinologie a metabolismu 1. LF UK a VFN v Praze
Published in the journal: Čas. Lék. čes. 2022; 161: 198-206
Category: Review Article

Summary

Graves’ ophthalmopathy (GO) occurs in 25–50% cases of Graves’ disease. Most cases are just mild, only 5% represents eye threatening diseases. About 5–10% of cases could be euthyroid and 10% hypothyroid, respectively. All patients with GO should be assessed for activity (clinical activity score – CAS) and severity of the disease. Essential conditions of the successful treatment are well controlled thyroid dysfunction, smoking cessation and to refer patients with moderate to severe and sight threatening GO to specialized thyroid eye centers as soon as possible.

Local therapy to maintain wet eye (lubricants) and supplementation of selenium deficiency is adequate in mild cases of GO. In cases of moderate to severe and sight threatening GO, administration of intravenous glucocorticoids in thyroid eye centers is first line treatment and a combination with mycophenolate or radiotherapy could be considered. When the first-line treatment fails or a contraindication/intolerance to them is present, non-steroid immunosuppressive drugs (mycophenolate, ciclosporin), rituximab, or radiotherapy could be considered. In rare cases of sight threatening GO urge surgical orbital decompression or tarsorrhaphy is warranted.

Keywords:

radiotherapy – mycophenolate mofetil – rituximab – Graves’ orbitopathy – clinical activity score – dysthyroid optic neuropathy – intravenous glucocorticoids

Zdroje

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Štítky

Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental Hygienist

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