The Features of the Clinical Course and Treatment of Moderately Severe Graves’ Ophthalmopathy in Patients with Graves’ Disease in Response to Catamnesis

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Objective. To document the course of Graves’ ophthalmopathy (GO), following immunosuppressive therapy and the spontaneous course of the disease in patients with Graves’ disease (GD). Design. Randomized study with three-year follow-up. Patients. 150 euthyroid patients with moderately severe GO. Intervention. In group 1 (n = 52) patients received glucocorticoids (GC) alone (prednisolone per os for 5 months, starting dose, 50—80 mg/d; or intravenous, 500—1000 mg/d, given during 3 days weekly; 5—6 cycles in all). Group 2 (n = 51) treated by GC in combination with orbital radiotherapy (16—20 Gy). None of 47 patients of group 3 treated with immunosuppressive therapy either due to contraindications to corticosteroids, or refusal of patients (spontaneous course of GO). Measurements: The activity of GO was scored by the method of Mourits et al., 1997, (Clinical Activity Score, CAS) and confirmed by the assessment of serum sICAM-1 (soluble form of intercellular adhesion molecule-1) and uGAGs (the urinary excretion of glycosaminoglycans). Results. Group 2 was characterized with the earliest establishment of the inactive GO (CAS J 2) (in 2.7 ± 1.4 months after beginning of the treatment) (p < 0.05), and the lowest frequency of deteriorations (p < 0,05). In the end of observation the “burnt out” stage of GO (fibrosis) was revealed in 98% of patients of group 2, that statistically differs from two other groups (p < 0.001). Group 3, in this respect, statistically did not differ from group 1 (45% vs 38%, P = 0.39), detected by comparison of CAS values, uGAGs, sICAM-1, obtained in inactive GO. Conclusions. 1) the absence of statistical verified differences of parameters, obtained in the inactive GO in groups 3 and 1 allow to use active observation at the planning of GO treatment; 2) the most effective strategy of treatment of moderately severe GO should be considered combined immunosuppressive therapy. Key words: graves’disease, ophthalmopathy, hyperthyroidism.