Endokrine Orbitopathie

Die endokrine Orbitopathie ist die häufigste extrathyreoidale Manifestation des Morbus Basedow. Die klinische Ausprägung ist variabel. Bei schwereren Manifestationen ist die Lebensqualität der Patienten meist erheblich gemindert. Im Gegensatz zu großen Fortschritten in der Grundlagenforschung, durch die Ansätze für zielgerichtete Target-Therapien sichtbar werden, ist die Translation in die Klinik langsam.

Die Therapie der Schilddrüsenüberfunktion als auch der entzündlichen Orbitopathie basiert im Wesentlichen auf Altbewährtem wie der thyreostatischen Therapie und einer Dämpfung des Immunsystems durch Steroide und Orbitaspitzenbestrahlung. Zulassungsstudien für Immunsuppressiva sind für die endokrine Orbitopathie nicht verfügbar, sodass für die Anwendung immer ein Off-Label-Antrag gestellt werden muss. Meist steht die aufwendige Antragsstellung der dringenden Behandlungssituation im Weg. Dies ist vor allem insofern problematisch, als sich in den wenigen randomisierten Studien gezeigt hat, dass nur eine frühe Therapie bei der endokrinen Orbitopathie effektiv ist.

Noch immer ist keine Therapie verfügbar, um bleibende Defekte durch Muskelfibrose und Fettvermehrung in der Augenhöhle vollständig zu vermeiden. Aus diesem Grund ist die chirurgische Therapie bleibender Defekte wesentlicher Inhalt der Therapie der Patienten mit moderaten und schweren Manifestationen.

• Literatur

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