Endocrine Abstracts

Background: Graves’ orbitopathy (GO) comprises mild, moderate-to-severe and severe forms. The treatment is complex, depending on the activity and severity of the disease. Patients with active moderate-to-severe GO benefit by correction of thyrotoxicosis and glucocorticoids (GC), as first-line agents. Approximately 20-40% of cases are not responsive to GC therapy.

Case presentations: There are presented two cases with active moderate-to-severe GO treated with antithyroid drugs (ATD) and GC iv (12 weeks, cumulative dose 4.5 g). After 3 months of therapy, case 1 showed a progression of the disease. The worsening of GO is reflected by: aggravation of current ophthalmic symptoms, alteration of ophthalmic parameters, an increase in CAS score and bilateralization of orbital involvement. Case 2 revealed after the same treatment, an improvement of ophthalmic symptoms and parameters, a decrease of CAS, but no effects on muscle involvement.

Conclusions: The causes of dissociated therapeutic responses in these similar cases were not elucidated. The unsuccessful therapeutic response may elicit: another course of i.v. GC therapy (lower doses), orbital radiotherapy associated with GC (oral and i.v.) or a combination of GC (oral and i.v.) with cyclosporine.