**Author details**

176 Thyroid Hormone

*Glucocorticoids*

alone.55

*Orbital Radiotherapy* 

*Orbital decompression* 

*Thyroid storm* 

*Other immunomodulatory therapy* 

onset or worsening of diplopia.

*Thyroid ophthalmopathy* 

and corneal ulcer is an emergency.

Mild to moderate ophthalmopathy does not require any specific treatment. General measures include control of thyrotoxicosis, smoking cessation, dark glasses with side frame for photophobia and sensitivity to air, artificial tear (1% methyl cellulose) or eye ointment for eye discomfort and dry eye, eye patches or taping during sleep for lagophthalmos, elevation of the head end for periorbital edema, prism for correction of mild diplopia.

Other patients with more severe signs and symptoms affecting daily lives to a significant extent may benefit from immunosuppressive therapy in active disease or surgical decompression in case of inactive disease. Severe ophthalmopathy with optic neuropathy

Oral glucocorticoids is initiated at a relatively high dose, such as 40-80 mg of prednisolone per day. After 2-4 weeks, the daily dose is tapered by 2.5-10 mg every 2-4 weeks. Improvement in soft tissue inflammation begins within 1-2 days. Intravenous methylprednisolone pulse therapy is more effective and better tolerated than oral prednisolone.54 500 mg of methylprednisolone per week for 6 weeks followed by 250 mg of methylprednisolone per week for 6 weeks is most commonly used regimen. Cyclosporine can also be used either as a single therapy or in combination with oral prednisolone. Combination therapy of cyclosporine with prednisolone is more effective than either drug

Orbital radiotherapy is well tolerated and provide benefit in approximately two third of

Rituximab, azathioprine, cyclophosphamide, ciamexon, pentoxifylline and intravenous

Indications for orbital decompression include optic neuropathy, severe proptosis, vision threatening ocular exposure, debilitating retrobulbar and periorbital pain and intolerable corticosteroid side effects. Transantral orbital decompression with removal of a portion of medial wall and the orbital floor is most commonly used procedure. Upto 5 mm reduction in proptosis can be achieved by orbital decompression. Orbital decompression can cause

Thyroid storm or thyrotoxic crisis is a life threatening exacerbation of hyperthyroidism. Most of the cases of thyroid storm are associated with Graves' disease, but it can also occur with toxic multinodular goitre. Precipitating factor for thyroid storm include infection,

patients. This treatment is steroid sparing rather than steroid replacing therapy.

immunoglobulins have some benefit and are currently under trial.

N.K. Agrawal and Ved Prakash *Department of Endocrinology and Metabolism, Institute of Medical Sciences,* 

Manuj Sharma *Department of Medicine, Gandhi Medical College, Bhopal* 

*Banaras Hindu University, Varanasi, India* 
