HIGH-DOSE INTRAVENOUS THERAPY WITH 7S IMMUNOGLOBULINS IN AUTOIMMUNE ENDOCRINE OPHTHALMOPATHY

Objective. Endocrine ophthalmopathy is an autoimmune disorder of the r etroorbital space tissues which is generally associated with thyroidal Graves' disease. Its pathogenetical aspects, clinical appearance and diagnostic procedures are reviewed. Therapeutic options include both e stablished and more experimental approaches. Increasing use of intrave nously administered immunoglobulin preparations has been noted in a va riety of autoimmunologically mediated diseases. We report preliminary data of an observational trial on high-dose immunoglobulin treatment i ncluding 10 patients suffering from thyroid eye disease. Methods. Opht halmopathy which had not been present for longer than 12 month and Gra ves' disease with an euthyroid metabolic state at the time of the inve stigation were the inclusion criteria. Therapy was commenced with a hi gh initial immunoglobulin dose of 20 g/d over a period of five days, a nd 4 further doses of 20 g each were administered at intervals of 4 we eks. Results. No significant decrease was found in the clinical ophtha lmopathy index and in thyroid-specific autoantibody levels. The eye mu scle index, determined radiologically by orbital computed tomography a s a parameter for inflammatory eye muscle involvement, also did not ch ange significantly during therapy. Conclusion. In contradiction to pre vious reports, our results do not at present allow a general recommend ation of high-dose immunoglobulin treatment in thyroid-related ophthal mopathy. Immunoglobulin therapy might be effective in selected patient s, but criteria for selection have to be defined.