Prednisone and cyclosporine in the treatment of severe Graves' ophthalmopathy

Article Abstract:

Graves' disease or hyperthyroidism is an endocrine condition in which excessive quantities of thyroid hormones are secreted into the bloodstream. As a result of this condition the patient's metabolic rate is increased and many adverse symptoms occur. Typical of Graves' disease is a group of pathologies of the eye (ophthalmopathy) including exophthalmos (bulging of the eyes) and a large increase in the size of the muscles which move the eyeball. The latter effect may limit the range of motion of the eye muscles. It remains unclear whether the ophthalmopathy of Graves' disease is directly related to Graves' disease or is a distinct and separate disease process. Ophthalmopathy may either predate or follow the onset of other symptoms of Graves' disease and it may persist following the restoration of normal levels of thyroid hormones that results from successful treatment. This study compares the effects of prednisone, an important anti-inflammatory corticosteroid, and cyclosporine, an immunosuppressive drug, in treating the ophthalmopathy of Graves' disease. One possible cause of this condition is an autoimmune reaction in which the body's own immune system is directed against the tissues of the eye, particularly the extrinsic muscles. Cyclosporine is an important immunosuppressive drug that has been used successfully to treat the serious immune reactions that occur following organ transplantation. This study examines the effects of these drugs on 36 previously untreated patients with severe Graves' ophthalmopathy (18 patients assigned to each group). The severity of eye disease was graded on a clinical scale before, during and after the various treatments. Following 12 weeks of treatment improvements were found in 11 of the 18 patients treated with prednisone, which was statistically better than the improvements in 4 of 18 patients treated with cyclosporine alone. Only patients treated with prednisone improved eye evaluation scores, visual acuity, and eye-movement. Patients who failed to respond to either medication after 12 weeks were given both drugs; some improvement was found in these patients who had not responded to single drug treatment.

Cyclosporine, Cyclosporins

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Use of corticosteroids to prevent progression of Graves' ophthalmopathy after radioiodine therapy for hyperthyroidism

Article Abstract:

Graves' disease or hyperthyroidism is an endocrine condition in which excessive quantities of thyroid hormones are secreted into the bloodstream. As a result of this condition, the patient's metabolic rate is increased and many adverse symptoms occur. Typical of Graves' disease is a group of pathologies of the eye (ophthalmopathy) including exophthalmos (bulging of the eyes) and a large increase in the size of the muscles which move the eye ball. The latter effect may limit the range of motion of the eyes. It remains unclear whether the ophthalmopathy of Graves' disease is directly related to Graves' disease or a distinct and separate disease process. Ophthalmopathy may either predate or follow the onset of other symptoms of Graves' disease and it may persist following the restoration of normal levels of thyroid hormones that results from successful treatment. The present study examines the ability of corticosteroids, important anti-inflammatory drugs, to prevent the progression of ophthalmopathy of Graves' disease. The study included 56 patients who had slight or no ophthalmopathy, and no progression of this condition during the three months before treatment of their underlying hyperthyroidism. All patients were treated with radioiodine to reduce their hyperthyroidism, and half the patients also received prednisone, a corticosteroid medication. Fifty-six percent of the patients not given prednisone had a significant increase in the degree of ophthalmopathy following the radioiodine procedure. In the other group, corticosteroids prevented the progression of eye disease in all patients and actually improved the pre-existing ophthalmopathy of 52 percent of patients. In patients with Graves' disease, short-term treatment with corticosteroids, administered simultaneously with radiotherapy, is recommended, particularly in patients with eye difficulties prior to radioiodine treatment.

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Relation between therapy for hyperthyroidism and the course of Graves' ophthalmopathy

Article Abstract:

Radioactive iodine (radioiodine) therapy followed by prednisone may reduce the eye disorders that sometimes accompany hyperthyroidism in Graves' disease. Patients can experience bulging of the eyes, double vision or eye inflammation. Researchers randomly assigned 443 patients with mild or no eye problems to receive one of three drug therapies. Eye problems developed or worsened in 15% of those who received radioiodine alone. Most patients who received methimazole had no eye changes. Eye problems improved in 67% of patients who received radioiodine and prednisone, an antiinflammatory drug.

Health aspects, Development and progression, Iodine, Iodine (Chemical element), Prednisone, Thyroid eye disease

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