Basedowian ophthalmopathy: diagnostic criteria and new therapeutical prospectives

Basedowian ophthalmopathy is an autoimmune disorder that occurs in 5% of patients affected by thyroid disease. These ocular and palpebral alterations cause severe aesthetic and functional damage. We studied five patients (age range: 54-65 years) who had undergone a new therapeutical protocol with immunoglobulin in high doses. The protocol foresaw the administration of intravenous Ig for two days every 21 days for seven courses. The drug used was human monomeric Ig, structurally unmodified. The control group consisted of 24 patients aged between 51 and 64 years treated with thyreostatics. The haematochemical requirements of the thyroid function, necessary to start the treatment, were the normalization of the following tests: TT3, TT4, FT3, FT4 and THS. If supported by other studies, on larger populations, treatment with intravenous Ig may be an important step forward in the cure of Basedowian ophthalmopathy, particularly as it does not cause the serious side effects that occur with steroid therapy. In fact, no relevant side effects were recorded in our study which included a follow-up of 2 years from the beginning of the treatment. However, because these therapeutical cycles are costly, we have not been able to treat a large number of patients (at present only patients with high ATA index have been given this treatment). Studies on larger populations may help to establish the most favourable time to begin therapy.