Endocrine Abstracts

Treatment of Graves’ orbitopathy (GO) remains a diagnostic and therapeutic challenge for clinicians all over the world. The elimination of risk factors, like encouraging smoking cessation, achieving euthyroidism and local measures usage are the most important and usually sufficient treatment methods in most mild cases. A course of selenium may also be beneficial. High-dose i.v. glucocorticosteroids remain the first-line therapy in moderate-to-severe orbitopathy, however in some patients such treatment may be insufficient. Radiotherapy for GO have been used for decades and is considered to be effective in active GO, however less than i.v. glucocorticosteroids. It effects mainly eye motility and soft tissue changes with almost no influence on exophthalmos. The combination of these two therapies has proven to be even more effective than either treatment alone, especially in subjects with resistant or recurrent GO. Orbital radiotherapy seems to be a safe procedure with a few adverse effects observed long after therapy. It should be avoided in patients with retinopathy due to diabetes mellitus, hypertensive subjects and young subjects (under 35 years old). Orbital radiotherapy, as a safe and generally effective second-line therapy, is used in some countries as a supporting method during the second course of i.v. glucocorticosteroids, if the response for the first course is not satisfactory. However, some more randomized, double-blind studies are needed to confirm fully its clinical usefulness.