Endocrine Abstracts

The diagnosis of TED is not always obvious and its management can be a challenging. Diagnosis as well as treatment should be performed in a multidisciplinary setting. Decision on treatment is based on a careful assessment of ophthalmological symptoms and the evaluation of the clinical activity of the disease using the clinical activity score. TED is classified into mild, moderate and sight threatening disease. An active inflammatory disease stage is followed by an inactive stage of incomplete remission in most of the patients. Periorbital swelling, proptosis, diplopia and lid retraction impair the quality of life of the patients severely. In the active state anti-inflammatory treatment is indicated. In milder stages a 6 months course of 200 μg Natriumselenid will suffice. In moderate TED i.v. steroids (cumulative dosage 4–5 g) in combination with orbital irradiation in cases with impaired motility are first choice. Off-label use of immunmodulatory medications (especially Rituximab 500–2000 g) may be considered if i.v. steroids do not suffice. All treatments have to be administered early enough before a fibrotic stage is reached. Inflammatory signs respond well, while impaired motility resolve only in one third of the patients and proptosis decrease only 1–2 mm. In rare cases sight threatening conditions like optic nerve compression, corneal ulceration, compartment syndrome with very high intraocular pressure develops and emergency decompression has to be performed. Persistent defects after maximal anti-inflammatory treatment can be successfully treated by surgery, when an inactive stable stage has been reached for at least 3 months and involve: decompression for proptosis reduction, muscle recession to correct diplopia and (finally) lid surgery. Anti-TSH-receptor-antibodies are specific for Graves’ disease and are related to both the course of thyroid and orbital disease and can be used for treatment decisions. Generally, environmental factors like smoking needs to be omitted. Thyroid function should be rapidly normalized, primarily using thyrostatic drugs. Definite therapy with radioiodine may be associated with negative effects, particularly when no protection with co-administered steroids is used. Recent data suggest a positive influence of thyroid surgery on the outcome especially if total ablation is reached. Adjuvant therapy like artificial teardrops, dark glasses and prisms to compensate diplopia are important.