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[Management of patient with Gaves' orbitopathy]

A Di Fiore1, L Paone, R Rendina

  • 1Dipartimenti di Medicina Sperimentale, Sapienza Università di Roma, Italia.

La Clinica Terapeutica
|January 12, 2013
PubMed

Insights

Graves' orbitopathy (GO), an autoimmune condition, requires tailored treatment based on severity and activity. Intravenous glucocorticoids are a primary therapy for active moderate-to-severe GO, showing high response rates.

Area of Science:

  • Endocrinology
  • Ophthalmology
  • Immunology

Context:

  • Graves' orbitopathy (GO) is the most frequent extrathyroidal manifestation of Flajani-Basedow-Graves' disease.
  • GO has an autoimmune etiology and can range from mild to severe and progressive forms.
  • Disease classification is based on severity, activity (Clinical Activity Score >=3), and quality of life impact.

Purpose:

  • To outline the therapeutic strategies for Graves' orbitopathy based on disease classification.
  • To detail the medical and surgical treatment options for mild, moderate-severe, and sight-threatening GO.
  • To review the efficacy and contraindications of various treatment modalities, including glucocorticoids and orbital radiotherapy.

Summary:

  • Mild GO management includes risk factor modification, local treatments, and selenium.
  • Active moderate-to-severe GO is treated with systemic or local glucocorticoids (GC), with intravenous pulse therapy showing a 79% response rate.
  • Orbital radiotherapy is effective in 60% of cases, with contraindications including diabetes mellitus and hypertension. Combined GC and radiotherapy enhance efficacy.

Impact:

  • Effective management strategies are crucial for preventing vision loss and improving quality of life in GO patients.
  • Understanding treatment efficacy and contraindications guides optimal patient selection for therapies like intravenous GC pulse therapy and orbital radiotherapy.
  • Further research into non-validated therapies like TNF-a inhibitors and rituximab may offer alternative options for refractory cases.

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