Table 8.

Clinical Situations That Favor a Particular Modality as Treatment for Active Moderate-to-Severe Thyroid Eye Disease

Clinical situation	IVGC/OGC	MMFa	RT	RTX	TEP	TCZ
Patients unresponsive or intolerant to GC	= b	?	√	√ /√√c	?	√
Adult patients <35 years of age	√	√ d	X	√ d	√ d	√ d
Chronic infectione	X	X	√	X	√ /√√	X
Liver disease	!/X	!	√	√	√ /√√	!/X
Active gastrointestinal disease	!	!	√	!	!/X	!/X
Cardiovascular disease	!/X	√	!/X f	!/X	√	√
Diabetes mellitusf	!/X	√	!/X	√	!/X	√
Chronic kidney disease	√	!	√	√	√	√

√√: favored choice; √: may be favored choice; !: cautious use; = : may be acceptable depending on the clinical circumstances; X: relative contraindication;?: insufficient evidence to recommend for or against treatment. Therapies are presented in alphabetical order.

^a Typically used as combination therapy with IVGC/OGC (please check contraindications to IVGC/OGC therapy).

^b In patients with relapsed TED after OGC or IVGC treatment (cumulative dose 4.5 g), a second cycle of IVGC (cumulative dose <8.0 g) may be considered.

^c May be more efficacious in TED of relatively short duration (<9 months).

^d All Women of childbearing potential must use effective contraception during treatment.

^e Chronic hepatitis, tuberculosis.

^f Diabetic and hypertensive retinopathies are contraindications to RT; uncontrolled diabetes is a contraindication to GC and TEP.

GC, glucocorticoid, RT, radiotherapy.