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1.
Q J Nucl Med Mol Imaging ; 65(2): 157-171, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33634673

RESUMO

Orbitopathy is the main extra thyroidal manifestation of Graves' disease. It is a very challenging condition, which requires a cooperation between many specialists (endocrinologists, ophthalmologists, radiologists, radiotherapeutic, orbital surgeons) for an optimal clinical management. An accurate diagnostic assessment is required, in order to plan an adequate treatment of Graves' orbitopathy. Medical therapy, radiotherapy or surgery may be necessary to control the disease. In this review, the authors analyze the various therapeutic strategies, as well the more recent therapies based on pharmacologic immunomodulation.


Assuntos
Antitireóideos/farmacologia , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/cirurgia , Oftalmopatia de Graves/terapia , Radioisótopos do Iodo/farmacologia , Fatores Etários , Terapia Combinada , Diabetes Mellitus , Humanos , Imageamento por Ressonância Magnética , Qualidade de Vida , Medição de Risco , Fatores Sexuais , Fumar , Glândula Tireoide , Tomógrafos Computadorizados , Ultrassonografia
2.
Radiol Med ; 126(2): 334-342, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32705522

RESUMO

PURPOSE: Glucocorticoids (GCs) and external radiotherapy (RT) are used for treating moderate-to-severe Graves' orbitopathy (GO). We aimed to assess whether GCs and RT were more effective when administered concomitantly or sequentially. METHODS: We retrospectively analyzed clinical outcomes [assessed by Clinical Activity Score (CAS) and NOSPECS classification] in 73 patients treated with both i.v. GCs and RT. The patients were divided in two groups: In group A (53 patients), RT was delivered concomitantly with GCs, and in group B (20 patients) RT was administered subsequently to the end of methylprednisolone. RESULTS: At baseline, CAS (median 4.0) and the percentage of patients encompassing the various grades of the classes 2, 3 and 4 of the NOSPECS score were similar in both groups. Six months after RT, CAS decreased to 2 in both groups (p = 0.0003 vs baseline) as well as NOSPECS class 4 (p < 0.0001 vs baseline). NOSPECS class 2 improved more in group A than in group B (p = 0.016). The median cumulative dose of GCs was lower in group A than in group B (median 4.500 vs 6000 mg, p < 0.007); the overall length of therapy was shorter in group A than in group B (68 vs 106 days, p < 0,02). The most common acute adverse effect was transient conjunctivitis (five in group A and three in group B); seven patients (five in group A and two in group B, age between 60 and 66 years) developed cataract, requiring surgery in five cases. CONCLUSIONS: Concomitant administration of GC and RT showed a favorable effect in moderate-to-severe GO, thus suggesting that RT should be carried out early during steroid therapy, when clinical symptoms do not improve or deteriorate after the first i.v. administrations of GCs.


Assuntos
Oftalmopatia de Graves/tratamento farmacológico , Oftalmopatia de Graves/radioterapia , Metilprednisolona/administração & dosagem , Esteroides/administração & dosagem , Terapia Combinada , Feminino , Oftalmopatia de Graves/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença
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