Efficacy of corticosteroids and external beam radiation in the management of moderate to severe thyroid eye disease

Christopher I. Zoumalan*, Kimberly P. Cockerham, Roger E. Turbin, Nicholas J. Volpe, Michael Kazim, Raymond S. Douglas, Steven E. Feldon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Thyroid Eye Disease (TED, Graves ophthalmopathy, thyroid ophthalmopathy) is the most common cause of orbital inflammation and proptosis in adults. There is no agreement on its management although corticosteroids and external beam orbital radiation (XRT) have traditionally been believed to provide benefit in active inflammation. Our review of the published literature in English disclosed an overall corticosteroid-mediated treatment response of 66.9% in a total of 834 treated patients who had moderate or severe TED. Intravenous corticosteroids used in repeated weekly pulses were more effective (overall favorable response = 74.6%, n = 177) and had fewer side effects than daily oral corticosteroids (overall favorable response = 55.5%, n = 265). A combination of corticosteroid and radiation therapy seemed to be more effective than corticosteroids alone. Our conclusions are tempered by a notable lack of standardization within and between study designs, treatment protocols, and outcome measures. Accordingly, the North American Neuro-Ophthalmology Society (NANOS), American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and the Orbital Society, in conjunction with Neuro-Ophthalmology Research and Development Consortium (NORDIC), will investigate the design and funding of a multi-center controlled trial.

Original languageEnglish (US)
Pages (from-to)205-214
Number of pages10
JournalJournal of Neuro-Ophthalmology
Issue number3
StatePublished - Sep 2007

ASJC Scopus subject areas

  • Ophthalmology
  • Clinical Neurology


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