Irish Journal of Medical Science (1971 -)

, Volume 186, Issue 3, pp 647–652 | Cite as

Radiotherapy for the treatment of thyroid eye disease—a prospective comparison: Is orbital radiotherapy a suitable alternative to steroids?

  • P. GrassiEmail author
  • D. Strianese
  • R. Piscopo
  • R. Pacelli
  • G. Bonavolontà
Original Article


Background and aims

To evaluate the efficacy of orbital radiotherapy (OR) for the treatment of thyroid eye disease (TED).


Thirty-five consecutive patients with active TED with contraindications to steroid therapy received a course of OR. Bilateral retrobulbar irradiation was performed with a total dose of 20 Gy. 7-points clinical activity score (7-CAS), ocular motility, visual acuity (VA), exophthalmos and eyelid retraction were prospectively evaluated at 3, 6 and 12 months and compared with baseline data.


There was a statistically significant improvement in 7-CAS at 3, 6 and 12 months post-treatment (p < 0.05). Ocular motility disturbances improved at 6 and 12 months (p < 0.05). Visual acuity remained stable; there was no significant change in exophthalmos (mean 24 mm, SD 3 mm) or eyelid retraction (marginal reflex distance mean 6 mm, SD 1.5 mm) during the follow-up period. No side effects were registered.


This study suggests that OR might be effective in reducing 7-CAS and ocular motility disturbances. No significant improvement in proptosis or eyelid retraction should be expected from this treatment. OR might be considered a suitable alternative treatment in TED for patients who cannot tolerate steroids.


Alternative first-line therapy Graves ophthalmopathy Orbital radiotherapy Thyroid eye disease 


Compliance with ethical standards

No funding/financial support was received for this submission.

Conflict of interest

Dr. Piergiacomo Grassi MD declares that he has no conflict of interest. Dr. Diego Strianese MD Ph.D. declares that he has no conflict of interest. Dr. Raffaele Piscopo MD Ph.D. declares that he has no conflict of interest. Dr. Roberto Pacelli MD declares that he has no conflict of interest. Prof. Dr. Giulio Bonavolontà MD declares that he has no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

It was obtained from all individual participants included in this study.


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Copyright information

© Royal Academy of Medicine in Ireland 2017

Authors and Affiliations

  • P. Grassi
    • 1
    Email author
  • D. Strianese
    • 1
  • R. Piscopo
    • 2
  • R. Pacelli
    • 3
  • G. Bonavolontà
    • 1
  1. 1.Department of Neuroscience, Odontostomatological and Reproductive SciencesUniversity “Federico II” of NaplesNaplesItaly
  2. 2.Department of OphthalmologyHumanitas Research HospitalMilanItaly
  3. 3.Department of Diagnostic Imaging and RadiotherapyUniversity “Federico II” of NaplesNaplesItaly

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