Die endokrine Orbitopathie ist eine entzündliche Orbitaerkrankung, die meist mit einer
Autoimmunhyperthyreose vom Typ Basedow auftritt. Entzündung, Exophthalmus und Doppelbilder
können die Lebensqualität der Patienten stark herabsetzen. Nur eine frühe antientzündliche
Therapie ist effektiv. Der Beitrag zeigt u. a., wann die Indikation dazu gestellt
werden muss und auch, wann nur noch operative Maßnahmen helfen.
Abstract
Background Gravesʼ orbitopathy (GO) is an autoimmune orbital disease which is mostly associated
with Graves’ disease and requires good interdisciplinary cooperation. To minimize
irreversible damages a stage-adapted anti-inflammatory therapy is of great importance.
Material and Methods Discussion of the latest results of new findings of the pathogenesis, randomized
controlled trials on anti-inflammatory treatments for Gravesʼ orbitopathy and novel
therapeutic concepts.
Results In all patients with GO achieving euthyroidism, as well as cessation of smoking is
very important to avoid prolongated diseases. Mild cases of GO can be treated with
selenium supplementation and artificial tears. The moderate-to-severe, active form
of GO requires primarily i. v. steroids in combination with orbital irradiation in
case of impaired motility. In patients with insufficient therapeutic response after
6 weeks, treatment should be switched to other immunosuppressive agents. In severe
sight-threatening cases even high-dose i. v. steroid treatments are often ineffective
and bony orbital decompression is necessary. As latest research data have improved
our understanding of the pathophysiology of GO, targeted therapies have been developed
for GO. Teprotumumab, an IGF-1 receptor antibody, was shown effective in treating
GO patients in a phase III trial and should soon be awarded approval for Europe. Inactive
patients, who suffer from disturbing exophthalmos should be also treated with bony
decompression before eye muscle or lid surgery.
Conclusion The current concept for Gravesʼ orbitopathy is as follows: first anti-inflammatory
therapy then surgical correction of the permanent defects. This might be modified
in the future, due to the promising effects of targeted therapies.
Schlüsselwörter
endokrine Orbitopathie - Morbus Basedow - Teprotumumab - EO
Key words
Graves’ orbitopathy - GO - Graves’ disease - Thyroid eye disease - thyroid
