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Pradhan A, Ganguly A, Naik MN, Nair AG, Desai S, Rath S. Thyroid eye disease survey: An anonymous web-based survey in the Indian subcontinent. Indian J Ophthalmol 2020; 68:1609-1614. [PMID: 32709788 PMCID: PMC7640870 DOI: 10.4103/ijo.ijo_1918_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the current practice patterns in the treatment of thyroid eye disease (TED) in Indian subcontinent through a web-based survey of members of Oculoplastics Association of India (OPAI). Methods This was an online web-based questionnaire survey disseminated via monkeysurvey.com to all ratified active members of OPAI between May 1, 2016 and June 30, 2016. Questions encompassed the background, training, region, and experience of oculoplastic surgeons along with the management protocol of TED. Results Of the 435 emails sent to OPAI members, 9 bounced and 180 (42.3%) responded within the study period. A large majority (96%) of respondents were oculoplastic surgeons practicing in India and the remaining practiced within South-East Asia. Two-thirds of respondents were oculoplastic surgeons with less than 10 years of clinical experience; 82% were fellowship trained in Oculoplasty. Almost all (99%) favored a multidisciplinary management of TED. A large majority routinely grade the severity (89%) and activity (87%) of disease before management. While corticosteroid remained the treatment of choice, 54% preferred immune-modulators as the second-line of therapy for recalcitrant TED. Three-quarters did not use orbital radiotherapy as a management modality in active TED owing to concerns over its efficacy and/or safety. Conclusion The survey gives useful insights to the practice patterns of TED management in Indian subcontinent. Multidisciplinary approach and grading of disease severity and activity were the rule rather than exception among OPAI members. Immune modulation was the preferred steroid-sparing agent in recalcitrant disease. Orbital radiotherapy was an uncommon treatment choice.
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Affiliation(s)
- Anuradha Pradhan
- Ophthalmic Plastic Surgery and Ocular Oncology Services, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, India
| | - Anasua Ganguly
- Ophthalmic Plastic Surgery and Ocular Oncology Services, LV Prasad Eye Institute, KVC Campus, Vijayawada, Andhra Pradesh, India
| | - Milind N Naik
- Ophthalmic Plastic Surgery and Ocular Oncology Services, LV Prasad Eye Institute, KAR Campus, Hyderabad, Telangana, India
| | - Akshay Gopinathan Nair
- Department of Oculoplastic Surgery and Ocular Oncology: Aditya Jyot Eye Hospital, Wadala, Mumbai, Maharashtra, India
| | - Savari Desai
- P.D Hinduja National Hospital, Mahim and Hinduja Healthcare Surgical, Mumbai, Maharashtra, India
| | - Suryasnata Rath
- Ophthalmic Plastic Surgery and Ocular Oncology Services, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, India
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Liu X, Wang S, Qin L, Qiang W, Dahal M, Fan P, Gao S, Shi B. Short and long-term effects of high-dose intravenous methylprednisolone pulse therapy on thyroid-associated ophthalmopathy. Exp Ther Med 2016; 12:901-908. [PMID: 27446294 PMCID: PMC4950155 DOI: 10.3892/etm.2016.3446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/07/2016] [Indexed: 12/30/2022] Open
Abstract
The majority of previous studies on high-dose intravenous methylprednisolone pulse (IVMP) therapy have observed the clinical conditions of patients prior to and following treatment without any long-term follow-up, and these studies have predominantly focused on combined treatment. The present prospective clinical study aimed to assess the long-term effects and safety of high-dose IVMP therapy in thyroid-associated ophthalmopathy (TAO), as well as the significance of thyrotropin receptor antibody (TRAb) and soluble intercellular adhesion molecule-l (sICAM-1) during IVMP therapy. A total of 58 patients with TAO were treated with high-dose IVMP therapy, and their clinical characteristics and indices were recorded before, during and after therapy, with a 12-57 month (mean, 28.4 months) follow-up. Before treatment and on the second day after each IVMP therapy, serum TRAb and sICAM-1 levels were evaluated in 23 patients with TAO via a competitive radioimmunoassay and enzyme-linked immunosorbent assay, respectively. The results of the present study demonstrated that the symptoms of eyelid swelling, ophthalmodynia, photophobia, lacrimation and diplopia, and visual acuity, ocular motility, proptosis and clinical activity score (CAS) indices were all significantly improved after IVMP therapy. In addition, analysis of covariance demonstrated that alterations in the levels of serum TRAb during the course of treatment were associated with CAS of TAO, whereas the change in serum sICAM-1 was not. In conclusion, high-dose IVMP therapy is an effective, safe, stable and well-tolerated treatment for TAO, which is associated with rare, minor adverse effects. Furthermore, serum TRAb levels are correlated with the CAS of TAO and may serve as a predictor of the response to methylprednisolone therapy.
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Affiliation(s)
- Xiaomei Liu
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China; Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Shu Wang
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Li Qin
- Department of Ophthalmology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Wei Qiang
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Mahesh Dahal
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Ping Fan
- Department of Rheumatism, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Shan Gao
- Department of Endocrinology, Shaanxi Provincial People's Hospital Affiliated to Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Bingyin Shi
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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Treatment of severe thyroid eye disease: a survey of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). Ophthalmic Plast Reconstr Surg 2015; 31:127-31. [PMID: 24988501 DOI: 10.1097/iop.0000000000000216] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate the current practice patterns for the treatment of severe thyroid eye disease (TED) in the United States by conducting a survey of the American Society of Ophthalmic Plastic and Reconstructive Surgery. METHODS This is a questionnaire study. The survey encompassed the use of different modalities, including intravenous steroids, oral steroids, orbital decompression, orbital radiation, intraorbital steroid injections, and steroid-sparing biologic agents, in the treatment of severe TED. Specifics on the dosing regimens of steroids and types of decompression used were queried. RESULTS With regard to treatments used "at all" in the management of severe TED, 87% use oral steroids and 74% use intravenous steroids. Eighty-three percent use orbital decompression, 70% use radiation, 33% use biologic agents, and 28% use intraorbital steroid injections. Oral steroids were slightly preferred to intravenous steroids at 43% versus 40% for first-line treatment. Most responders (61%) chose 2-wall decompression as their preferred technique. CONCLUSIONS Severe TED can be a devastating disease leading to diplopia and vision loss. Treatment recommendations have varied and continue to evolve. The survey reported herein found that oral steroids were slightly preferred over intravenous steroids by the members of the American Society of Ophthalmic Plastic and Reconstructive Surgery, most of who practice in the United States. This is in contrast to survey results from European and Latin American physicians, which more strongly favored intravenous steroids. In addition, orbital decompression and orbital radiation still play significant roles in the management of severe TED.
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Xu SH, Li XJ, Chen GF, Zheng QX, Yang Y, Hu YX, Wang K, Liu C. A questionnaire survey on the management of Graves' orbitopathy in China: A comparison with Europe and Latin-America. Chronic Dis Transl Med 2015; 1:117-123. [PMID: 29062996 PMCID: PMC5643564 DOI: 10.1016/j.cdtm.2015.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Management of Graves' orbitopathy (GO) continues to be a challenge to clinical endocrinologists. In the last few years, surveys on GO management have succeeded in elucidating trends in Europe and Latin America. To determine how endocrinologists in China assess and treat patients with GO and gain insight into how to make the management of this disease more uniform and standardized. METHODS Based on the questionnaire used in the European survey on GO, a questionnaire in China was drafted and circulated to the members of Chinese Society of Endocrinology (CSE) during the annual meeting. RESULTS A total of 124 valid responses were analysed. Almost all respondents (94.4%) claimed that a multidisciplinary approach for GO management was valuable. Over 80% of the participants advocated the assessment of exophthalmometry, vision, visual fields by perimetry, eye movements, and fundoscopy. Glucocorticoids were preferred as the first-line therapy by 92.7% of respondents, among them, 59.7% choose the intravenous route. The treatment strategy for GO with intravenous glucocorticoids therapy still remains debatable. Anti-thyroid drugs (ATDs) were the most common choice (72.6%) for first-line therapy of coexisting hyperthyroidism. Treatment options for GO were very similar among Chinese, Latin-American and European respondents, whereas radioactive iodine and surgical treatment were more often indicated for co-existing hyperthyroidism in China. CONCLUSION The appropriate treatment for patients with GO is controversial even among thyroid specialists. Further training of thyroid specialists, easier access of patients to multidisciplinary centres and establishment of practice guidelines are required for the management of this condition in China.
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Affiliation(s)
- Shu-Hang Xu
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
| | - Xing-Jia Li
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
| | - Guo-Fang Chen
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
| | - Quan-Xi Zheng
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
| | - Yu Yang
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
| | - Yong-Xin Hu
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
| | - Kun Wang
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
| | - Chao Liu
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
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Wong J, Wiseman SM. Thyroid surgery for treatment of Graves' disease complicated by ophthalmopathy: a comprehensive review. Expert Rev Endocrinol Metab 2015; 10:327-336. [PMID: 30298775 DOI: 10.1586/17446651.2015.1010515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Graves' disease (GD) is an autoimmune disorder in which antibodies directed against thyroid-stimulating hormone receptors leads to thyrotoxicosis. Graves' ophthalmopathy, a condition that occurs in up to half of GD patients, is a cause of significant morbidity and is potentially vision threatening. Three treatment options are equally effective for uncomplicated GD and these include thyroid surgery (thyroidectomy), radioactive iodine thyroid ablation and antithyroid drugs. However, recent practice surveys suggest that surgery is the least favored GD treatment. When GD is complicated by moderate-to-severe Graves' ophthalmopathy, antithyroid drugs and surgery are recommended by current guidelines, and again the preference for thyroid surgery in these cases has remained low. This report aims to review current published data regarding thyroidectomy as a treatment for GD, and in particular, we focus on the effects of thyroidectomy on Graves' ophthalmopathy development and progression.
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Affiliation(s)
- Jordan Wong
- a Department of Surgery, St. Paul's Hospital and University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
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Sundar G, Chiam N, Lun K, Koh V. Survey of common practices among oculofacial surgeons in the Asia-Pacific region: Graves' orbitopathy. Orbit 2014; 33:319-25. [PMID: 25121573 DOI: 10.3109/01676830.2014.938168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIM A web-based anonymous survey was performed to evaluate practice preferences in the management of Graves' orbitopathy amongst oculofacial surgeons in the Asia-Pacific region. METHODS A questionnaire with contentious topics in Graves' orbitopathy was sent out via email to oculofacial surgeons in 14 countries within Asia-Pacific between May to December 2012. RESULTS A response rate of 25.2% to 34.6% was achieved (32-44 of 127 participants). 61.0% of respondents encountered Graves' orbitopathy commonly in their practice. The more common causes of vision loss in Graves' orbitopathy included dysthyroid optic neuropathy (67.5%) and exposure keratopathy (15.0%). The clinical activity score was the most popular grading system for assessing Graves' orbitopathy. The preferred non-surgical therapeutic approaches included intravenous pulsed methylprednisolone (79.5%), oral steroids (56.4%), orbital radiation (12.8%), steroid-sparing immunosuppressants (10.3%) and watchful observation (7.7%). Thyroid orbital decompression was uncommonly or rarely performed by respondents. Orbital surgical decompression was most commonly performed via the two-wall technique (73.5%) and most respondents performed fat decompression (69.4%). Post-operatively, the most common complications include under correction (45.5%) and diplopia (42.4%). CONCLUSION We report the results of the first survey on the management of Graves' orbitopathy amongst oculofacial surgeons in Asia-Pacific. Our respondents practice preferences reflected the Graves' orbitopathy management consensus statement by the European group on Graves' orbitopathy in 2008.
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Affiliation(s)
- Gangadhara Sundar
- Department of Ophthalmology, National University Health System , Singapore
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Yang M, Perros P. Management plan and delivery of care in Graves' ophthalmopathy patients. Best Pract Res Clin Endocrinol Metab 2012; 26:303-11. [PMID: 22632367 DOI: 10.1016/j.beem.2012.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Most patients with Graves' orbitopathy have mild disease that requires no or minimal intervention. For the minority of patients with moderate or severe disease, multiple medical and surgical treatments may be required at different stages. It is crucial that such patients are monitored closely and treatments applied with care in the right sequence. Medical treatments should be used as early as possible and only during the active phase of the disease. Rehabilitative surgery is indicated in the inactive phase of the disease and should follow the sequence: surgical decompression followed by eye muscle surgery, followed by lid surgery. Delivery of care in a coordinated fashion that makes use of best available expertise is important and best implemented through a Combined Thyroid Eye clinic.
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Affiliation(s)
- Morgan Yang
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Singapore.
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Abstract
AIMS The purpose of this study was to obtain data on orbital decompression procedures performed in England, classed by hospital and locality, to evaluate regional variation in care. METHODS Data on orbital decompression taking place in England over a 2-year period between 2007 and 2009 were derived from CHKS Ltd and analysed by the hospital and primary care trust. RESULTS AND CONCLUSIONS In all, 44% of these operations took place in hospitals with an annual workload of 10 or fewer procedures. Analysis of the same data by primary care trust suggests an almost 30-fold variance in the rates of decompression performed per unit population. Expertise available to patients with Graves' orbitopathy and rates of referral for specialist care in England appears to vary significantly by geographic location. These data, along with other outcome measures, will provide a baseline by which progress can be judged.
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Abstract
Thyroid eye disease (TED) is a chronic debilitating condition causing physical discomfort, facial disfigurement and impaired visual function. The physical consequences of TED could have a negative and lasting impact on patients' employment, hobbies and psychosocial function. In this review, we assess the evidence of the impact of TED on patients' quality of life (QOL) and also explore the effects of suboptimal quality of care on QOL of patients with this disease. It is hoped that recent initiatives, including the Amsterdam declaration, to raise the quality of care for patients with TED will help to improve their QOL.
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Affiliation(s)
- Stephanie Estcourt
- Department of Endocrinology Ophthalmology, Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK
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Hendrick AM, Kahook MY, Daoud YJ, Hazin R. Ophthalmic manifestations of endocrine disorders: approaches and medical management. Curr Opin Ophthalmol 2009; 20:495-503. [PMID: 19752729 DOI: 10.1097/icu.0b013e328331903c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Disorders of the endocrine system may present with various ophthalmic signs, symptoms, and pathology. Early detection, prevention, and monitoring of these manifestations can significantly benefit morbidity associated with such disease states including permanent visual dysfunction. RECENT FINDINGS Several studies highlight the importance of early diagnosis in reducing the long-term complications associated with these endocrine conditions, although these observations are mostly based on case reports and case series. SUMMARY This review will focus on the connection of endocrine-related disease states with the development of specific ophthalmic pathology and is geared towards the general medical practitioner. The focus of the treating physician should be on facilitating early diagnosis to prevent potentially blinding complications.
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Affiliation(s)
- Andrew M Hendrick
- University of Colorado Denver, Department of Ophthalmology Denver, Colorado, USA
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Estcourt S, Hickey J, Perros P, Dayan C, Vaidya B. The patient experience of services for thyroid eye disease in the United Kingdom: results of a nationwide survey. Eur J Endocrinol 2009; 161:483-7. [PMID: 19542244 DOI: 10.1530/eje-09-0383] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A recent consensus statement from the European Group on Graves' Orbitopathy recommends referring all patients with thyroid eye disease (TED), except the mildest cases, to a specialist multidisciplinary clinic. OBJECTIVE To study the patients' experiences of accessing services for the treatment of TED in the UK. METHODS A postal questionnaire survey of 395 members of two patients support organisations for TED in the UK, the TED Charitable Trust and the British Thyroid Foundation. RESULTS The response rate was 67%. The majority of responders were females (91%) and aged above 45 (74%). There were delays in the diagnosis and referral. In 26% of responders, the time lapsed from the first symptoms to the diagnosis of TED for over 12 months. There was a wide variation in the type of clinic and healthcare professionals involved in the treatment of TED. Only 25% of the responders attended a specialist TED clinic. Out of these, 33% waited over 6 months from the first consultation with a doctor to being seen at a specialist TED clinic. Only 56% of responders were satisfied with the treatment they received for TED. More responders who had attended a specialist TED clinic were satisfied with the treatment than those who had not attended a specialist clinic (67 vs 52%, P<0.05). CONCLUSION Only a minority of patients with TED are treated at a specialist TED clinic in the UK. Those patients who are treated at a specialist TED clinic are more likely to be satisfied with the treatment.
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Affiliation(s)
- Stephanie Estcourt
- Department of Endocrinology, Royal Devon and Exeter Hospital and Peninsula Medical School, Exeter EX2 5DW, UK
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Abstract
Advances in the past few years have helped clinicians understand some of the pathogenetic mechanisms of Graves orbitopathy (GO), particularly the role of receptors for TSH and insulin-like growth factor I in the orbit. Optimal treatment strategies have been formulated and published by the European Group on Graves' Orbitopathy, which are hoped to improve the management of patients with this condition. The administration of intravenous pulses of steroids has been established as a superior treatment approach compared with other steroid regimens. In addition, orbital radiotherapy was effective in a subgroup of patients with GO who had eye dysmotility. The use of immunotherapies for the treatment of GO is currently being explored; of these, rituximab has emerged as a promising new agent.
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Affiliation(s)
- Petros Perros
- Endocrine Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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