High-dose intravenous therapy with 7S immunoglobulins in autoimmune endocrine ophthalmopathy

Endocrine ophthalmopathy is an autoimmune disorder of the retroorbital space tissues which is generally associated with thyroidal Graves' disease. Its pathogenetical aspects, clinical appearance and diagnostic procedures are reviewed. Therapeutic options include both established and more experimental approaches. Increasing use of intravenously administered immunoglobulin preparations has been noted in a variety of autoimmunologically mediated diseases. We report preliminary data of an observational trial on high-dose immunoglobulin treatment including 10 patients suffering from thyroid eye disease.

Ophthalmopathy which had not been present for longer than 12 month and Graves' disease with an euthyroid metabolic state at the time of the investigation were the inclusion criteria. Therapy was commenced with a high initial immunoglobulin dose of 20 g/d over a period of five days, and 4 further doses of 20 g each were administered at intervals of 4 weeks.

No significant decrease was found in the clinical ophthalmopathy index and in thyroid-specific autoantibody levels. The eye muscle index, determined radiologically by orbital computed tomography as a parameter for inflammatory eye muscle involvement, also did not change significantly during therapy.

In contradiction to previous reports, our results do not at present allow a general recommendation of high-dose immunoglobulin treatment in thyroid-related ophthalmopathy. Immunoglobulin therapy might be effective in selected patients, but criteria for selection have to be defined.