Treatment of Graves' ophthalmopathy by steroid therapy, orbital radiation therapy, plasmapheresis and thyroxine replacement

Abstract

Thirteen patients with moderately severe ophthalmopathy due to Graves' disease were treated by steroid therapy, supervoltage orbital radiotherapy, plasmapheresis and thyroxine replacement. All patients complained of chemosis, ocular pain and diplopia. The mean value of proptosis was 21.3 mm. Eleven patients (84.6%) showed some improvement, but the effect was mostly on the symptoms of orbital soft tissue involvement. The effect on proptosis was rather unsatisfactory. In six patients (46.2%) proptosis decreased by 2.3 mm on the average, but they still had more noticeable exophthlamos than patients with Graves' disease without infiltrative ophthalmopathy. For regression of proptosis, radiation therapy was the most beneficial therapeutic regimen in this study, especially in the patients who received the treatment shortly after the beginning of malignant exophthlamos.