The Features of the Clinical Course and Treatment of Moderately Severe Graves’ Ophthalmopathy in Patients with Graves’ Disease in Response to Catamnesis

Abstract

Objective. To document the course of Graves’ ophthalmopathy (GO), following immunosuppressive therapy and the spontaneous course of the disease in patients with Graves’ disease (GD). Design. Randomized study with three-year follow-up. Patients. 150 euthyroid patients with moderately severe GO. Intervention. In group 1 (n = 52) patients received glucocorticoids (GC) alone (prednisolone per os for 5 months, starting dose, 50—80 mg/d; or intravenous, 500—1000 mg/d, given during 3 days weekly; 5—6 cycles in all). Group 2 (n = 51) treated by GC in combination with orbital radiotherapy (16—20 Gy). None of 47 patients of group 3 treated with immunosuppressive therapy either due to contraindications to corticosteroids, or refusal of patients (spontaneous course of GO). Measurements: The activity of GO was scored by the method of Mourits et al., 1997, (Clinical Activity Score, CAS) and confirmed by the assessment of serum sICAM-1 (soluble form of intercellular adhesion molecule-1) and uGAGs (the urinary excretion of glycosaminoglycans). Results. Group 2 was characterized with the earliest establishment of the inactive GO (CAS J 2) (in 2.7 ± 1.4 months after beginning of the treatment) (p < 0.05), and the lowest frequency of deteriorations (p < 0,05). In the end of observation the “burnt out” stage of GO (fibrosis) was revealed in 98% of patients of group 2, that statistically differs from two other groups (p < 0.001). Group 3, in this respect, statistically did not differ from group 1 (45% vs 38%, P = 0.39), detected by comparison of CAS values, uGAGs, sICAM-1, obtained in inactive GO. Conclusions. 1) the absence of statistical verified differences of parameters, obtained in the inactive GO in groups 3 and 1 allow to use active observation at the planning of GO treatment; 2) the most effective strategy of treatment of moderately severe GO should be considered combined immunosuppressive therapy. Key words: graves’disease, ophthalmopathy, hyperthyroidism.