علاج اعتلال حجاج غريفز النشط متوسط إلى شديد الخطورة مع جحوظ العين والرؤية المزدوجة

References

DOI: 10.1530/EJE-21-0479

• GO is defined as active if CAS is ≥ 3/7 (Table 2).
• Lid retraction ≥ 2 mm; moderate or severe soft-tissue involvement; exophthalmos ≥ 3 mm above normal for race and gender; inconstant or constant diplopia.
• Patients without sight-threatening GO whose eye disease has sufficient impact on daily life to justify the risks of immunosuppression (if active) or surgical intervention (if inactive).
• Intravenous methylprednisolone in combination with oral mycophenolate sodium (or mofetil) represents the first-line treatment for moderate-to-severe and active GO.
• In the more severe forms of moderate-to-severe and active GO, including constant/inconstant diplopia, severe inflammatory signs and exophthalmos > 25 mm, i.v. methylprednisolone at the highest cumulative dose (7.5 g per cycle) as monotherapy represents an additional valid first-line treatment.
• Moderate-to-severe and active GO: hyperthyroidism should be treated with ATDs until treatment of GO is completed.
• It is composed of entirely objective measures: ≥2-mm reduction of lid aperture, ≥1 point reduction in five-item CAS (excluding subjective, patient-reported spontaneous or gaze-evoked pain), ≥2 mm reduction in exophthalmos, ≥8° increase of eye muscle duction.
• Improvement in ≥2 features in one eye without deterioration in the other eye might be considered a positive response to treatment.
• Optimally, the outcome of treatment should be assessed 3 months after the last therapeutic intervention, but, in addition, changes after 6 months can also be considered.