Endocrine Abstracts

Introduction

Graves orbitopathy is the main extra thyroidal manifestation of Graves’ disease, though severe forms are rare (< 5%). Management of Graves orbitopathy is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. The aim of our study was to evaluate different treatment modalities and assess their impact on the outcome of Graves orbitopathy.

Patients and methods

We conducted a retrospective study including 50 patients with Graves orbitopathy. Clinical and therapeutic data were collected.

Results

Participants had a mean age of 41.1 ± 16.6 years and a sex-ratio (M/F) of 0.38. Eighteen patients were smokers. Proptosis was bilateral in 96% of cases and asymmetric in 57%. Referring to EUGOGO criteria, 32 patients had a mild form, 15 patients did not receive any treatment and 17 had local topical eye care. The outcome was marked by stabilization in 20 patients, remission in 2 patients and regression of manifestations in 7 patients. Thirteen patients had a moderate to severe form and were put on oral glucocorticoids (Prednisone 0.5-1 mg/kg/d) in 5 cases and on intravenous glucocorticoids (Methylprednisolone 1 g/d for 3 consecutive days) followed by oral glucocorticoids in 8 cases. The outcome in this group was marked by worsening in one case. Five patients had a very severe orbitopathy and were treated with intravenous glucocorticoids (Methylprednisolone 1 g/d for 3 consecutive days followed by 500 mg repeated every week for 6 weeks). Two of them got their ocular manifestations regressed and two patients got their orbitopathy stabilized. Absence of response was noticed in one case.

Conclusion

Our study illustrated the difficulty of management of Graves orbitopathy which remains a therapeutic challenge and dilemma. Novel pharmacological treatments are on the horizon and might target pathogenetic mechanisms of the disease better than glucocorticoids.