This article is more than 5 years old. Information may no longer be current.
Combined steroid, radiotherapy may be best for moderate thyroid disease
Click Here to Manage Email Alerts
LONDON – Moderate ocular thyroid disease may be best managed by a combination of steroids and radiotherapy, according to a speaker here at the Moorfields Bicentenary scientific meeting.
Jimmy M. Uddin, FRCOphth, of Moorfields Eye Hospital, described to attendees how the management of moderate ocular thyroid disease has evolved over the past 20 years and presented an overview of the literature on the topic.
In published trials, Mr. Uddin said, 64% of patients with moderate ocular thyroid disease spontaneously improved, 22% remained stable and 14% progressed. Oral prednisone resulted in improvement in 60% to 65% of patients, while intravenous methylprednisone resulted in improvement in 75%.
Radiotherapy alone does not seem to produce significant results, he said, according to one study, but another published study showed a 60% improvement with either radiotherapy alone or prednisone alone.
“Just because a study showed something to be statistically significant doesn’t mean the therapy should be advocated,” Mr. Uddin said, noting that in some studies statistical significance is not supported by clinical relevance to the patient.
“Oral steroids and radiotherapy [in combination] are more effective than either method alone,” he said. “Intravenous steroids are even more effective. Using just cyclosporine has not proven effective.”
Because a number of the studies reviewed reached different conclusions, Mr. Uddin noted that Moorfields plans to study the combination of steroids and radiotherapy. All enrolled patients will be given oral steroids for 2 weeks; only those who show an improvement will continue in the study, he said, and they will then be given azathiapine.
Mr. Uddin said the new study will be the world’s largest on this disease. Enrollment is expected to begin shortly.