علاج فرط نشاط الغدة الدرقية المصطنع مع مرض العين الدرقي النشط من المعتدل إلى الشديد (CAS ≥ 3)

References

DOI: 10.1089/thy.2016.0229

• The tool grades the severity of thyroid eye disease into 3 categories mild, moderate to severe, and sight threatening thyroid eye disease and is a useful tool for directing therapy.
• Thyroid orbitopathy is considered active in patients with a CAS ≥ 3.
• Rapid correction of hyperthyroidism with anti-thyroid drugs.
• Intravenous steroid i.e. 4.5g methylprednisolone (IVMP) given in 12 weekly infusions (0.5g weekly X 6 weeks followed by 0.25g weekly for an additional 6 weeks) is indicated.
• The cumulative dose of intravenous methylprednisolone should not be more than 8g.
• In the case of use of oral glucocorticoids, treatment should be with prednisolone 60mg-100mg daily, gradually tapered down by 5–10 mg/week until withdrawal in 3 months.
• Local subconjunctival/periocular injections of triamcinolone acetate may be considered when systemic glucocorticoids are absolutely contraindicated.