Treatment of thyroid associated ophthalmopathy : Comparison between radiotherapy with concurrent steroids and three floor orbital decompression

Abstract Thyroid associated orbitopathy is a common manifestation of Graves’ disease. There are many options which can be considered for treatment of this condition. In this case series, we reviewed the medical records of 16 patients suffering from thyroid ophthalmoplegia. 8 of them received radiotherapy and concurrent steroids and other 8 of them underwent 3 floor orbital decompression. They had a median follow up of around 2 years (from 2009 to 2011). After a median follow-up of 2 years, a subjective improvement in exophthalmos and vision was reported by nearly all patients at the end of RT but only 4 patients reported a decrease in their diplopia immediately after therapy. Symptoms continued to improve with time in many patients: 25% had complete reversal of their symptoms and signs, and the remaining 75% had partial improvement. But none of the patients who underwent surgery had improvement in diplopia, 3 of them had new onset diplopia. Only proptosis was corrected among them. We conclude that RT is an effective treatment option in Graves Ophthalmopathy. Based on our own clinical experiences and the literature data, the combination of RT and intravenous corticosteroid administration may improve the response rate.