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Management of Severe Thyroid Eye Disease and Use of Biological Agents

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Thyroid Eye Disease

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Abstract

Multiple classification and grading systems exist for thyroid eye disease (TED) but for the purpose of this chapter, severe disease broadly includes severe inflammatory orbitopathy, sight-threatening disease, and/or proptosis greater than 25 mm.

The management of severe TED may require multiple treatment modalities. The roles of immunosuppression, orbital radiation, and orbital decompression strategies are placed in the context of severe disease. The traditional primary systemic immunosuppression remains corticosteroids, although other immunosuppression therapies including azathioprine and the newer biologic therapies such as rituximab and tocilizumab are presented. Smoking cessation remains important in disease control.

Severe TED management typically requires a multidisciplinary approach involving endocrinologists, neuro-ophthalmologists, orbital and strabismus surgeons. Once the inflammatory disease has been controlled, surgical rehabilitation can restore function, aesthetics, and quality of life.

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Authors and Affiliations

  1. Department of Clinical Sciences and Community Health, Graves Orbitopathy Unit, Fondazione Ca’Granda IRCCS, University of Milan, Milan, Italy

    Mario Salvi M.D.

  2. Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Center, University of California San Diego, La Jolla, CA, USA

    Richard L. Scawn M.B.B.S., F.R.C.Ophth, Roman Farjardo M.D., Bobby S. Korn M.D., Ph.D., F.A.C.S. & Don O. Kikkawa M.D., F.A.C.S.

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  1. Mario Salvi M.D.
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  2. Richard L. Scawn M.B.B.S., F.R.C.Ophth
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  3. Roman Farjardo M.D.
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  4. Bobby S. Korn M.D., Ph.D., F.A.C.S.
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  5. Don O. Kikkawa M.D., F.A.C.S.
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Corresponding author

Correspondence to Don O. Kikkawa M.D., F.A.C.S. .

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Editors and Affiliations

  1. Division of Eye Plastic, Orbital, and Facial Cosmetic Surgery, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA

    Raymond S. Douglas

  2. Division of Eye Plastic, Orbital, and Facial Cosmetic Surgery, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA

    Allison N. McCoy

  3. Division of Eye Plastic, Orbital, and Facial Cosmetic Surgery, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA

    Shivani Gupta

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Salvi, M., Scawn, R.L., Farjardo, R., Korn, B.S., Kikkawa, D.O. (2015). Management of Severe Thyroid Eye Disease and Use of Biological Agents. In: Douglas, R., McCoy, A., Gupta, S. (eds) Thyroid Eye Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1746-4_9

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