Efficacy of combined orbital radiation and systemic steroids in the management of Graves’ orbitopathy

  • Ji Won Kim
  • Sun Hyup Han
  • Byeong Jae Son
  • Tyler Hyungtaek Rim
  • Ki Chang Keum
  • Jin Sook YoonEmail author
Oculoplastics and Orbit



To compare the efficacy and safety of combination therapy with orbital irradiation and systemic steroids versus steroid monotherapy in the management of active Graves’ orbitopathy (GO).


The clinical charts of 127 patients with active inflammation due to GO who received intravenous steroid pulse therapy as a first-line treatment with or without orbital radiotherapy between 2010 and 2014 were reviewed. Patients were divided into two treatment groups: 1) combined orbital radiotherapy and steroid pulse therapy (SRT group) and 2) steroid pulse therapy only (ST group). Primary outcome measures included clinical activity score (CAS); NOSPECS classification; ocular motility impairment; and exophthalmos at 1, 3, 6, and 12 months after treatment. The secondary outcome measure was the change in orbital, extraocular muscle (EOM), and fat volume after treatment measured by orbit computed tomography.


Sixty-eight patients were included in the SRT group, and 59 patients were in the ST group. In both treatments, CAS and NOSPECS were significantly reduced. In the comparison of the degree of change from baseline between the groups, the SRT group demonstrated more improvement in NOSPECS and scores of ocular motility. Orbital, EOM, and fat volume significantly decreased in the SRT group; however, only fat volume was reduced in the ST group. Compressive optic neuropathy after treatment developed in 0 % of the SRT group and 3.4 % (2/59) of the ST group. Reactivation of inflammation occurred in 11.8 % (8/68) of the SRT group and 28.8 % (17/59) of the ST group.


Orbital radiotherapy in combination with steroid treatment significantly improved ocular motility by reducing EOM volume in patients with active GO.


Orbital radiation Systemic steroids Graves’ orbitopathy Thyroid-associated orbitopathy 


Compliance with ethical standards

For this type of study, formal consent is not required.


This work was supported by the Bio & Medical Technology Development Program of the National Research Foundation(NRF) funded by the Korean government (grant number NRF-2015M3A9E2067031). The sponsor had no role in the design or conduct of this research.

Conflict of interest

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Supplementary material

417_2016_3280_MOESM1_ESM.jpg (370 kb)
Supplementary Fig. 1 Flow diagram of inclusion for study subjects (JPG 369 kb)
417_2016_3280_MOESM2_ESM.docx (28 kb)
Supplementary Table 1 (DOCX 28 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Ji Won Kim
    • 1
  • Sun Hyup Han
    • 2
  • Byeong Jae Son
    • 3
  • Tyler Hyungtaek Rim
    • 1
  • Ki Chang Keum
    • 4
  • Jin Sook Yoon
    • 1
    Email author
  1. 1.Institute of Vision Research, Department of OphthalmologyYonsei University College of MedicineSeoulSouth Korea
  2. 2.Yonsei University College of MedicineSeoulKorea
  3. 3.Department of OphthalmologyKyungpook National University School of MedicineDaeguKorea
  4. 4.Department of Radiation Oncology, Yonsei Cancer HospitalYonsei University College of MedicineSeoulKorea

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