Can combination of glucocorticoids with other immunosoppressive drugs reduce the cumulative dose of glucocorticoids for moderate-to-severe and active Graves’ orbitopathy?

  • M. L. Tanda
  • E. Piantanida
  • E. Masiello
  • C. Cusini
  • L. BartalenaEmail author

Graves’ orbitopathy (GO) is the main non-thyroidal expression of Graves’ disease [1]. Management of moderate-to-severe and active forms of the disease remains a major and not completely solved therapeutic challenge and dilemma [2]. Glucocorticoids are, for the time being, the first-line treatment, usually given intravenously in 12 weekly infusions, with a cumulative dose of 2.5–7.5 g of methylprednisolone, more commonly 4.5 g [2]. Intravenous glucocorticoids are effective, particularly in inactivating the disease, but some features of GO, namely exophthalmos and longstanding extraocular muscle restriction, are not very responsive [2]. Treatment is more effective if duration of GO is < 1 year [1]. Relapses after treatment withdrawal are not infrequent [2]. In addition, large doses of glucocorticoids are needed, and this may cause severe adverse events, including liver toxicity, hypertension, diabetes, psychosis [2]. Therefore, the addition of a second drug aimed at reducing the dose of...


Graves’ orbitopathy Intravenous glucocorticoids Methotrexate Cyclosporine 


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Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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This paper did not involve patients.


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Copyright information

© Italian Society of Endocrinology (SIE) 2019

Authors and Affiliations

  • M. L. Tanda
    • 1
  • E. Piantanida
    • 1
  • E. Masiello
    • 1
  • C. Cusini
    • 1
  • L. Bartalena
    • 1
    Email author
  1. 1.Endocrine Unit, ASST dei Sette Laghi, Department of Medicine and SurgeryUniversity of InsubriaVareseItaly

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