Keywords:
Thyroid / Parathyroids, Eyes, CT, Radiation therapy / Oncology, Endocrine disorders
Authors:
E. Isdale, Z. Thotathil; Hamilton/NZ
DOI:
10.26044/ranzcr2019/R-0112
Conclusion
Orbital radiotherapy with concurrent steroid therapy is an appropriate intervention in severe TED where steroids have failed or can’t be used and there is a wish to avoid going straight to decompressive surgery. The short term radiotherapy side-effects were negligible and long term effects in our small cohort appear to be minimal based on current follow up data.
All patient in our audit had at least a mild improvement in symptoms, greater than half had moderate or significant improvment at >6months. Disappointly 4 eventually required decompressive surgery but interestingly there was minimal difference in the amount of time that patients had eye symptoms in terms of the need for eventual decompression. The range was identical (1-21months) and the median was 12 months for all and 9 months for the patients that required decompression.
Demographically our population is similar to a 2016 study carried out at Waikato in relation to thyrotoxicosis and use of RAI [7]. Age (median 52 and 53.7 years) and gender breakdown was very similar but concerningly the amount of Maori patients given radiotherapy was lower than found in [7{ (9% vs 31.9%) and also lower than the current Waikato maori population that sits at 20%.
Some issues with this audit was the overall population size, 21% of total patients with incomplete follow up but also having a standardised screening test before and 6 months after treatment could help in assessing our overall success with orbital radiation.
New modalities of treatment for TED include the use of IMRT which gives satisfactory symptom control with an acceptable post radiotherapy complication profile [5].