From the Guidelines
Teprotumumab is the most effective medication for improving malignant exophthalmos or Graves' induced orbitopathy, as it has been shown to reduce proptosis and the clinical activity score of disease in many patients with active disease 1.
Treatment Options
When considering treatment for malignant exophthalmos or Graves' orbitopathy, several options are available, including:
- Artificial tears and lubricants to manage ocular surface symptoms
- High-dose systemic glucocorticoids, such as intravenous methylprednisolone pulses, for moderate-to-severe active disease
- Teprotumumab, an insulin-like growth factor-1 receptor inhibitor, for patients with active disease
- Selenium supplementation for mild cases with selenium deficiency
- Other biologics, such as Tocilizumab, Rituximab, or Fingolimod, may be considered in certain cases
Disease Management
The goal of treatment is to reduce the clinical activity score of the disease, improve ocular alignment, and reduce diplopia.
- Orbital decompression, high-dose pulse steroid infusion, and orbital radiation treatment may be indicated in severe cases 1.
- Strabismus surgery may be necessary to restore ocular alignment and improve vision.
- Patients should be counseled to cease smoking and avoid exposure to ionizing radiation to reduce the risk of orbitopathy 1.
Medication Efficacy
Teprotumumab has been shown to improve subjective diplopia scores in both active and chronic TED and reduce the need for strabismus surgery 1.
- Selenium supplementation has been shown to reduce some inflammatory symptoms in patients with milder TED, but it does not impact control of hyperthyroidism in populations that are not selenium deficient 1.
- High-dose systemic glucocorticoids are effective in reducing inflammation and improving symptoms, but they may have significant side effects.
From the Research
Medications for Malignant Exophthalmos or Graves' Induced Orbitopathy
The following medications have been found to improve malignant exophthalmos or Graves' induced orbitopathy:
- IV Steroids/oral prednisolone: High-dose intravenous corticosteroid therapy has been shown to be effective in treating Graves' ophthalmopathy, with significant improvements in proptosis, diplopia, and optic neuropathy 2, 3, 4.
- Specific treatments for severe cases:
Treatment Approach
The treatment approach for Graves' orbitopathy should be multidisciplinary, taking into account the severity and activity of the disease 5, 6.
Comparison of Treatment Options
Studies have compared the effectiveness and tolerability of different treatment options, including intravenous and oral glucocorticoids, and found that high-dose intravenous glucocorticoids may be more effective and better tolerated than oral glucocorticoids 3, 4.