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Klinische Wochenschrift

, Volume 63, Issue 19, pp 1000–1004 | Cite as

Treatment of graves' ophthalmopathy with cyclosporin a

  • A. Witte
  • R. Landgraf
  • A. Markl
  • K.-P. Boergen
  • G. Hasenfratz
  • C. R. Pickardt
Originalien

Summary

To evaluate the effect of Cyclosporin A in the management of Graves' ophthalmopathy, we treated 13 patients with severe euthyroid endocrine eye disease with the immunosuppressive drug. Follow up consisted of clinical investigation, laboratory evaluation with detailed thyroid function tests and complete ophthalmological assessments including A and B scan ultrasound and computerized tomography (CT) of the orbits. Cyclosporin A given over 4–7 months resulted in improvement of clinical signs and symptoms of the disease due to a positive effect of the drug on soft tissue changes. The more objective methods did not demonstrate any unequivocal change in proptosis, visual acuity, intraocular pressure and thickness of extraocular muscles. Cyclosporin A was not able to stop acute progression of ophthalmopathy in one patient and did not obviate surgical decompression of the orbits in two more patients. There was no measurable effect of treatment on the underlying immunological process with regard to thyroid disease.

Key words

Graves' ophthalmopathy Cyclosporin A ultrasonogram computerized tomography proptosis extraocular muscle thickness 

Abbreviations

CT

computerized tomography

CyA

Cyclosporin A

TBG

thyroxine binding globulin

TDA

TSH displacing activity

T3

triiodothyronine

T4

thyroxine

TSH

thyroid stimulating hormone

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References

  1. 1.
    Beveridge T (1982) Cyclosporin A, 1st edn, Elsevier Biomedical Press, Amsterdam, pp 561–564Google Scholar
  2. 2.
    Bigos ST, Nisula BC, Daniels GH, Eastman RC, Johnston HH, Kohler PO (1979) Cyclophosphamide in the management of advanced Graves' ophthalmopathy. Ann Int Med 90:921–923CrossRefPubMedGoogle Scholar
  3. 3.
    Brabant G, Peter H, Becker H, Schwarzrock R, Wonigeit K, Hesch RD (1984) Cyclosporin in infiltrative eye disease. Lancet 1:515–516CrossRefPubMedGoogle Scholar
  4. 4.
    DeSanto LW, Gorman CA (1973) Selection of patients and choice of operation for orbital decompression in Graves' ophthalmopathy. Laryngoskope 83:945–952CrossRefGoogle Scholar
  5. 5.
    Enzmann DR, Donaldson SS, Kriss JP (1979) Appearance of Graves' disease on orbital computed tomography. J Comput Assist Tomogr 3 (6):815–819CrossRefPubMedGoogle Scholar
  6. 6.
    Erhardt F, Marschner I, Pickardt CR, Scriba PC (1973) Verbesserung und Qualitätskontrolle der radioimmunologischen Thyrotropin-Bestimmung. J Clin Chem Clin Biochem 11:381–387Google Scholar
  7. 7.
    Howlett TA, Lawton NF, Pells P, Besser GM (1984) Deterioration of severe Graves' ophthalmopathy during cyclosporin treatment. Lancet 2:1101CrossRefPubMedGoogle Scholar
  8. 8.
    Kelly W, Longson D, Smithard D, Fawcitt R, Wensley R, Noble J, Keeley J (1983) An evaluation of plasma exchange for Graves' ophthalmopathy. Clin Endocrinol 18:485–493CrossRefGoogle Scholar
  9. 9.
    Kirmse L, Lahrtz H-G, Schemmel K, Waschulzik G (1975) Totale Thyreoidektomie bei progredienter endokriner Orbitopathie. Dtsch Med Wochenschr 100:535–537CrossRefPubMedGoogle Scholar
  10. 10.
    Markl A, Boergen KP, Hasenfratz G, Mayr B, Fink U, Lissner J (19884) Cumputerized tomography in the evaluation of endocrine ophthalmopathy. Acta Endocrinol 105 Suppl 264:84Google Scholar
  11. 11.
    Ossoinig KC (1984) Ultrasonic diagnosis of Graves' ophthalmopathy. In: Gorman CA et al. (eds) The eye and orbit in thyroid disease. Raven Press, New York, pp 185–211Google Scholar
  12. 12.
    Teng CS, Crombie AL, Hall R, Ross WM (1980) An evaluation of supervoltage orbital irradiation for Graves' ophthalmopathy. Clin Endocrinol 13:545–551CrossRefGoogle Scholar
  13. 13.
    Utech Ch H, Wulle KD, Kiefer H (1985) Cyclosporin A-Behandlung bei schwerer endokriner Ophthalmopathie (Leserzuchrift). Dtsch med Wochenschr 110:155–156PubMedGoogle Scholar
  14. 14.
    Weetman AP, Ludgate M, Mills PV, McGregor AM, Beck L, Lazarus JH, Hall R (1983) Cyclosporin improves Graves' ophthalmopathy. Lancet 2:486–489CrossRefPubMedGoogle Scholar
  15. 15.
    Werner SC (1977) Modification of the classification of the eye changes of Graves' disease: recommendations of the ad hoc committee of the American Thyroid Association (editorial). J Clin Endocrinol Metab 44:203–204CrossRefPubMedGoogle Scholar
  16. 16.
    Witte A, Habermann J, Pickardt CR (1982) Is TSH-displacing activity a helpful parameter in diagnosis and follow-up of Graves' disease. Acta Endocrinol Suppl 246:73Google Scholar

Copyright information

© Springer-Verlag 1985

Authors and Affiliations

  • A. Witte
    • 1
  • R. Landgraf
    • 1
  • A. Markl
    • 1
  • K.-P. Boergen
    • 1
  • G. Hasenfratz
    • 1
  • C. R. Pickardt
    • 1
  1. 1.Medizinische und Radiologische Klinik Innenstadt und AugenklinikUniversität MünchenGermany

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