13.8  Oculoplastics

TED = thyroid eye disease; IVMP = intravenous methylprednisolone

EUGOGO [lxxxiii]

Consensus guidelines for TED treatment with corticosteroids

Key Points
  • Treat active TED (CAS ≥ 4) with IVMP:
    • 500mg weekly for 6 weeks, then 250mg weekly for 6 weeks
  • Treat sight-threatening TED (optic neuropathy or corneal exposure) with IVMP:
    • 1g daily for 3 days
  • Lifetime cumulative IVMP dose should not exceed 8g
    • Risk of fatal hepatotoxicity

Risk Factors
  • Key risk factors for poor disease control:
    • Cigarette smoking
    • Poor TFT control
  • Radioactive iodine precipitates active TED

Bartalena, L., Baldeschi, L., Dickinson, A.J. et al. 2008. Consensus statement of the European group on Graves' orbitopathy (EUGOGO) on management of Graves' orbitopathy. Thyroid 18(3) 333-346.

OPTIC [lxxxiv]

P3 trial - teprotumomab for active TED

Teprotumomab effective for treatment of active TED compared to placebo, (reducing proptosis, diplopia and clinical activity and improving QOL). Safe

No comparison made with IVMP

Douglas, R.S., Kahaly, G.J., Patel, A. et al. 2020. Teprotumumab for the Treatment of Active Thyroid Eye Disease. N Engl J Med 382(4) 341-352.


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