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.
Similar content being viewed by others
Abbreviations
- CT:
-
computerized tomography
- CyA:
-
Cyclosporin A
- TBG:
-
thyroxine binding globulin
- TDA:
-
TSH displacing activity
- T3 :
-
triiodothyronine
- T4 :
-
thyroxine
- TSH:
-
thyroid stimulating hormone
References
Beveridge T (1982) Cyclosporin A, 1st edn, Elsevier Biomedical Press, Amsterdam, pp 561–564
Bigos ST, Nisula BC, Daniels GH, Eastman RC, Johnston HH, Kohler PO (1979) Cyclophosphamide in the management of advanced Graves' ophthalmopathy. Ann Int Med 90:921–923
Brabant G, Peter H, Becker H, Schwarzrock R, Wonigeit K, Hesch RD (1984) Cyclosporin in infiltrative eye disease. Lancet 1:515–516
DeSanto LW, Gorman CA (1973) Selection of patients and choice of operation for orbital decompression in Graves' ophthalmopathy. Laryngoskope 83:945–952
Enzmann DR, Donaldson SS, Kriss JP (1979) Appearance of Graves' disease on orbital computed tomography. J Comput Assist Tomogr 3 (6):815–819
Erhardt F, Marschner I, Pickardt CR, Scriba PC (1973) Verbesserung und Qualitätskontrolle der radioimmunologischen Thyrotropin-Bestimmung. J Clin Chem Clin Biochem 11:381–387
Howlett TA, Lawton NF, Pells P, Besser GM (1984) Deterioration of severe Graves' ophthalmopathy during cyclosporin treatment. Lancet 2:1101
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 18:485–493
Kirmse L, Lahrtz H-G, Schemmel K, Waschulzik G (1975) Totale Thyreoidektomie bei progredienter endokriner Orbitopathie. Dtsch Med Wochenschr 100:535–537
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 264:84
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 185–211
Teng CS, Crombie AL, Hall R, Ross WM (1980) An evaluation of supervoltage orbital irradiation for Graves' ophthalmopathy. Clin Endocrinol 13:545–551
Utech Ch H, Wulle KD, Kiefer H (1985) Cyclosporin A-Behandlung bei schwerer endokriner Ophthalmopathie (Leserzuchrift). Dtsch med Wochenschr 110:155–156
Weetman AP, Ludgate M, Mills PV, McGregor AM, Beck L, Lazarus JH, Hall R (1983) Cyclosporin improves Graves' ophthalmopathy. Lancet 2:486–489
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 44:203–204
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 246:73
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Witte, A., Landgraf, R., Markl, A. et al. Treatment of graves' ophthalmopathy with cyclosporin a. Klin Wochenschr 63, 1000–1004 (1985). https://doi.org/10.1007/BF01737636
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF01737636