October - December 2007, Volume 3, Issue 4

Valea A, Baciu C, Zaharia R, Duncea I

The efficacy of cyclosporine treatment in controling evolutive Graves' ophtalmopathy

Acta Endo (Buc) 2007, 3 (4): 483-492
doi: 10.4183/aeb.2007.483

Graves’ disease is an autoimmune disorder characterized by various degrees of thyroid gland, eye and skin affection. We present the case of a 36 years old woman diagnosed with Graves’ disease and infiltrative ophthalmopathy class IV according to Werner classification, non-responsive to Methylprednisolone antiinflammatory therapy and to irradiation. From anamnesis we mention Graves’ disease’s debut approximately one year ago, manifested by thyrotoxicosis features without evident ophthalmopathy. Antithyroid drug therapy was started at debut and maintained for eleven months. One month after antithyroid drug therapy cessation, the patient developed diplopia, periorbital edema, and proptosis. At that moment we decided to initiate intravenous Methylprednisolone therapy using a total dose of 3 grams, followed by oral corticotherapy in association with antithyroid drug therapy. One month later, when bilateral fat tissue hernia appeared in the external orbital angle, we decided to add orbital radiotherapy. In the absence of any evident clinical improvement, immunosuppressive treatment with Cyclosporine 5 mg/kg/day was chosen. Consequently, ,we obtained a significant reduction of eye proptosis, 4 mm at the right eye, and 3 mm at the left eye, a significant reduction of bilateral orbital fat tissue hernia, and no more diplopia.

Keywords: ophthalmopathy, antiinflammatory therapy in Graves? ophthalmopathy

Correspondence: Ana Valea, MD, str Aleea Padin, Nr 20, Bl V1, Sc C, Ap 74, Cluj-Napoca, Romania, e-mail: ana74us@yahoo.com