Radiotherapy for the treatment of thyroid eye disease—a
prospective comparison: Is orbital radiotherapy
a suitable alternative to steroids?
Received: 6 June 2016 / Accepted: 25 December 2016 / Published online: 3 January 2017
Ó Royal Academy of Medicine in Ireland 2017
Background and aims To evaluate the efﬁcacy of orbital
radiotherapy (OR) for the treatment of thyroid eye disease
Methods Thirty-ﬁve consecutive patients with active TED
with contraindications to steroid therapy received a course
of OR. Bilateral retrobulbar irradiation was performed with
a total dose of 20 Gy. 7-points clinical activity score (7-
CAS), ocular motility, visual acuity (VA), exophthalmos
and eyelid retraction were prospectively evaluated at 3, 6
and 12 months and compared with baseline data.
Results There was a statistically signiﬁcant improvement
in 7-CAS at 3, 6 and 12 months post-treatment (p \ 0.05).
Ocular motility disturbances improved at 6 and 12 months
(p \ 0.05). Visual acuity remained stable; there was no
signiﬁcant change in exophthalmos (mean 24 mm, SD
3 mm) or eyelid retraction (marginal reﬂex distance mean
6 mm, SD 1.5 mm) during the follow-up period. No side
effects were registered.
Conclusions This study suggests that OR might be effec-
tive in reducing 7-CAS and ocular motility disturbances.
No signiﬁcant improvement in proptosis or eyelid retrac-
tion should be expected from this treatment. OR might be
considered a suitable alternative treatment in TED for
patients who cannot tolerate steroids.
Keywords Alternative ﬁrst-line therapy Á Graves
ophthalmopathy Á Orbital radiotherapy Á Thyroid eye
Thyroid eye disease (TED) is an autoimmune disease
involving the retro-ocular and peri-ocular tissues associ-
ated with Graves’ disease [1, 2]. Typical signs and symp-
toms include proptosis, retro-orbital pain, tearing, ocular
soft tissues inﬂammation, eyelid retraction, conjunctival
redness and edema, corneal lesions, impaired extraocular
motility with or without diplopia, periorbital edema, visual
impairment and, rarely, blindness .
Treatment options for TED include immunosuppressive
agents, radiotherapy, and various surgical procedures such
as orbital decompression, squint surgery, and correction of
eyelid retraction [3–5].
Glucocorticoids are still the most widely used
immunosuppressive agents for the treatment of TED, and
appear to be the most effective for associated soft tissue
inﬂammation, optic neuropathy and extraocular muscles
impairment [6, 7]. The main disadvantages of gluco-
corticoid therapy are the potential recurrence of the
disease after discontinuation and the side effects in long-
term treatment . Several alternative therapies have
been proposed to manage resistant TED such as orbital
radiation therapy, several other immunosuppressive
agents and biological drugs. However, the effectiveness
of these treatments is still widely debated in the litera-
& P. Grassi
Department of Neuroscience, Odontostomatological and
Reproductive Sciences, University ‘‘Federico II’’ of Naples,
via Pansini no 5, 80131 Naples, Italy
Department of Ophthalmology, Humanitas Research
Hospital, Rozzano, Milan, Italy
Department of Diagnostic Imaging and Radiotherapy,
University ‘‘Federico II’’ of Naples, Naples, Italy
Ir J Med Sci (2017) 186:647–652