RESUMO
Thyroid eye disease (TED) is the most frequent extrathyroidal manifestation of Graves' disease. In most instances it is mild and non-progressive, but in 3%-5% of cases it is severe. Non-severe TED requires only supportive measures, such as eye ointments, sunglasses and prisms. By contrast, severe TED requires aggressive treatment, either medical (high-dose glucocorticoids, orbital radiotherapy) or surgical (orbital decompression). The choice of treatment relies on the assessment of both TED severity and activity. Removal of controllable risk factors, especially cigarette smoking, is important to improve the course and the therapeutic outcome. A coordinated approach to the treatment of hyperthyroidism and TED is also required. Novel promising treatments, to be verified in large series of patients, include somatostatin analogues and cytokine antagonists.
Assuntos
Diplopia/terapia , Doença de Graves/terapia , Doenças do Nervo Óptico/terapia , Somatostatina/análogos & derivados , Antitireóideos/uso terapêutico , Terapia Combinada , Descompressão Cirúrgica , Diplopia/tratamento farmacológico , Diplopia/etiologia , Diplopia/radioterapia , Diplopia/cirurgia , Dispositivos de Proteção dos Olhos , Pálpebras/cirurgia , Glucocorticoides/uso terapêutico , Doença de Graves/complicações , Doença de Graves/tratamento farmacológico , Doença de Graves/radioterapia , Doença de Graves/cirurgia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Radioisótopos do Iodo/uso terapêutico , Octreotida/uso terapêutico , Músculos Oculomotores/cirurgia , Pomadas , Soluções Oftálmicas , Doenças do Nervo Óptico/tratamento farmacológico , Doenças do Nervo Óptico/etiologia , Doenças do Nervo Óptico/radioterapia , Doenças do Nervo Óptico/cirurgia , Peptídeos Cíclicos/uso terapêutico , Fotofobia/etiologia , Fotofobia/terapia , Plasmaferese , Abandono do Hábito de Fumar , Somatostatina/uso terapêutico , TireoidectomiaRESUMO
During a period of 17 years (from 1976 till now) 45 patients with giant gliomas of the chiasma and the IIIrd ventricle out of a total amount of 120 patients with hypothalamic gliomas were operated. The following classification of tumours was used: I) tumours with predominant anterior growth; II) tumours which infiltrate chiasma and penetrate into the IIIrd ventricle; III) gliomas of the floor of the IIIrd ventricle and the chiasma, growing into the ventricle cavity; IV) tumours of the chiasma, optic tract and thalamus. The authors come to the conclusion, that surgical removal of giant tumours of the chiasma and the IIIrd ventricle, though risk, may result in an improvement or stabilisation of visual functions (77%) and a long period free from recurrencies (9.5%). The postoperative period is relatively favourable and the mortality is low (6%). The main contraindication in our opinion is a wide infiltration of adjacent brain structures by the tumour and spreading along both optical tracts. We consider the giant size of a tumour in itself a sufficient indication for surgery.