Endokrine Orbitopathie

Die endokrine Orbitopathie ist eine entzündliche Orbitaerkrankung, die meist mit einer Autoimmunhyperthyreose vom Typ Basedow auftritt. Entzündung, Exophthalmus und Doppelbilder können die Lebensqualität der Patienten stark herabsetzen. Nur eine frühe antientzündliche Therapie ist effektiv. Der Beitrag zeigt u. a., wann die Indikation dazu gestellt werden muss und auch, wann nur noch operative Maßnahmen helfen.

Abstract

Background Gravesʼ orbitopathy (GO) is an autoimmune orbital disease which is mostly associated with Graves’ disease and requires good interdisciplinary cooperation. To minimize irreversible damages a stage-adapted anti-inflammatory therapy is of great importance.

Material and Methods Discussion of the latest results of new findings of the pathogenesis, randomized controlled trials on anti-inflammatory treatments for Gravesʼ orbitopathy and novel therapeutic concepts.

Results In all patients with GO achieving euthyroidism, as well as cessation of smoking is very important to avoid prolongated diseases. Mild cases of GO can be treated with selenium supplementation and artificial tears. The moderate-to-severe, active form of GO requires primarily i. v. steroids in combination with orbital irradiation in case of impaired motility. In patients with insufficient therapeutic response after 6 weeks, treatment should be switched to other immunosuppressive agents. In severe sight-threatening cases even high-dose i. v. steroid treatments are often ineffective and bony orbital decompression is necessary. As latest research data have improved our understanding of the pathophysiology of GO, targeted therapies have been developed for GO. Teprotumumab, an IGF-1 receptor antibody, was shown effective in treating GO patients in a phase III trial and should soon be awarded approval for Europe. Inactive patients, who suffer from disturbing exophthalmos should be also treated with bony decompression before eye muscle or lid surgery.

Conclusion The current concept for Gravesʼ orbitopathy is as follows: first anti-inflammatory therapy then surgical correction of the permanent defects. This might be modified in the future, due to the promising effects of targeted therapies.

Schlüsselwörter

endokrine Orbitopathie - Morbus Basedow - Teprotumumab - EO

Key words

Graves’ orbitopathy - GO - Graves’ disease - Thyroid eye disease - thyroid

Publication History

Article published online:
13 October 2021

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