Management of Thyroid Eye Disease
The most common medical interventions – corticosteroids and/or external beam radiation – are typically reserved for patients with a vision-threatening active phase or rapidly progressive orbitopathy.
Rationale for Using Corticosteroids for TED.
- Oral corticosteroid treatment (usually Prednisone) has been associated with a short term decrease in soft tissue swelling, optic neuropathy and extraocular muscle size in up to 65% of cases
- The clinical response to intravenous corticosteroids is as high as 85% with fewer side effects than oral Prednisone
Rationale for Using External Beam Radiation.
Data addressing the efficacy of orbital irradiation, either alone or in combination with other treatment modalities (corticosteroids, steroid-sparing agents, surgery) is conflicting. Overall improvement rates of 60-65% are typical in reported studies treating TED patients in the active phase of the disease. Radiation can decrease redness, swelling and discomfort; but is not routinely effective in reducing proptosis or double vision. Radiation can also be used effectively if optic neuropathy is present in an actively inflamed TED patient. Radiation is contraindicated in Diabetics.
The Role of Surgery in Thyroid Eye Disease
In most cases, surgery is delayed and is targeted at modification of stable phase dysfunction.
Orbital Decompression surgery is effective in decreasing or eliminating the bulging (proptotic) eyes.
Eyelid retraction repair surgery is effective in decreasing or eliminating the stare that is so characteristic of TED. The eyelids are often staying open at night and causing break down of the surface of the eye.
Eye muscle surgery is performed to restore single vision when looking straight ahead and down. Unfortunately, there is no way to return the muscle function to normal âÂÂÂ€ÂÂÂ“ so double vision in extremes of gaze is a common permanent change.
Although late surgical interventions can help decrease disfigurement and allow the patient to see a single image when looking straight ahead, the tissue alterations are irreversible. There is no way to restore normal eye muscle movement or pre-disease appearance. Thus, many of the manifestations of TED are permanent.
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