Radiotherapy for Active Thyroid Eye Disease

Purpose: To critically review the published literature on orbital radiotherapy as a treatment modality for thyroid eye disease (TED). Methods: A systematic review and analysis of the relevant published literature was performed. Results: Thyroid eye disease is an autoimmune condition that is amenable to treatments that modulate the immune response, including orbital radiotherapy (ORT). Ideal candidates for ORT are patients in the early, active phase of TED with moderate to severe, or rapidly progressive, disease, including patients with significant motility deficits and compressive optic neuropathy. Patients with progressive strabismus may also benefit. Patients with mild or inactive disease will not benefit from ORT when compared with the natural history of the disease. Orbital radiotherapy should generally be used in conjunction with corticosteroid therapy, with response to corticosteroids demonstrating the immunomodulatory therapeutic potential of ORT. When treating TED-compressive optic neuropathy, ORT may help obviate the need for urgent surgical decompression, or postpone it until the stable, inactive phase of the disease. Orbital radiotherapy treatment doses should approach 20 Gy in most cases, but lower doses may be considered in younger patients without significant dysmotility. The safety profile of ORT is well established, and side effects are minimal in appropriately selected patients. Conclusions: Radiotherapy is a safe and effective treatment for active TED in appropriately selected patients. Accepted for publication December 14, 2017. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Michael Kazim, M.D., Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, 635 W. 165th Street, New York, NY. E-mail: mk48@cumc.columbia.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.