MEDICAL-MANAGEMENT OF GRAVES OPHTHALMOPATHY

In most patients with Graves' hyperthyroidism the eye signs are self-l imiting and mostly subclinical, However, about one-third of the patien ts have clinically relevant ophthalmopathy, which can be disabling and disfiguring, The mechanical causes of the symptoms and signs of the e ye disease are largely understood, but the best way to manage the opht halmopathy is still a matter of much debate, Adequate treatment of hyp erthyroidism can aleviate the eye symptoms to some extent, but it is l ess clear which kind of antithyroid treatment is to be preferred in pa tients with opathalmopathy. There is particular controversy about the possibly deleterious effect of radioiodine therapy on the ophthalmopat hy; in view of the present evidence it seems prudent to refrain from u sing I-131 and to prefer antithyroid drugs in patients with clinical o phthalmopathy, Further medical management can include immunosuppressiv e treatment (such as corticosteroids) that results in improvement in r oughly two-thirds of the patients, Orbital irradiation appears to be t he first choice for treatment in moderately severe ophthalmopathy beca use it is equally effective and much better tolerated than classical c orticosteroid treatment, However, to really improve the efficacy of su ch interventions we should be able to select those patients that are l ikely to respond to immunomodulatory therapy, Disease activity is prob ably the prime determinant of response and it is a challenge for the f uture to develop reliable parameters of disease activity on the basis of which patients can be Selected for further medical treatment, or ca n be subjected to rehabilitative surgery without prior immunosuppressi on.