Immunosuppressive therapy in patients with thyroid eye disease: an overview of current concepts

Thyroid eye disease (TED) is a debilitating disease impairing the quality o f life of affected patients. Treatment is often not satisfactory. This revi ew summarizes the existing literature and discusses the most widely used fo rms of treatment for TED such as glucocorticoids (GCs), and other immunosup pressive agents. GCs are the most commonly used treatment in patients with TED. Other immunosuppressive agents such as cyclosporin A, azathioprin, cyc lophosphamide and ciamexone have been used, but the results are modest at b est and indicate an unfavorable benefit-risk relationship. Limited experien ce indicates that methotrexate may be effective even in patients with refra ctory TED. Somatostatin analogs, octreotide and lanreotide, may provide a v aluable, although costly therapeutic alternative to GCs. Orbital radiothera py has been used in the management of TED for almost 60 years. However. its beneficial effects have been questioned recently by several studies, the d etails of which have not yet been published. Other studies have argued in f avor of orbital radiotherapy: however, the benefits appear to be limited to improvement of extraocular muscle dysfunction.