Endocrine Abstracts

Introduction: Graves’ ophthalmopathy, also called Graves’ orbitopathy, is a potentially sight-threatening ocular disease that has puzzled physicians and scientists for nearly two centuries. Generally occurring in patients with hyperthyroidism or a history of hyperthyroidism due to Graves’ disease, Graves’ ophthalmopathy is also known as thyroid-associated ophthalmopathy or thyroid eye disease, because it sometimes occurs in patients with euthyroid or hypothyroid chronic autoimmune thyroiditis. We report two cases of Graves’ ophthalmopathy and review clinical presentation, diagnosis and management of this condition.

Observation: Observation 1 A 52-year-old patient, with a history of hyperthyroidism since 1 year, referred for evaluation of the activity of his thyroid eye disease. Ophthalmologic examination found bilateral proptosis with right eyelid inocclusion, bilateral conjunctival hyperemia and superficial punctate keratitis. Oculomotricity and the remainder of the ophthalmological examination were without abnormalities in both eyes. The patient was successfully treated with corticosteroids.

Observation 2: A 55-year-old patient presented with complains of right proptosis and orbital pain for the past month. His medical history included diabetes treated with oral hypoglycemic agents. Examination revealed right ophthalmoplegia with exophthalmos. The remainder of the ophthalmological examination was unremarkable. The left eye was without abnormalities. A thyroid assessment carried out showed patent hyperthyroidism. Anti-TSH receptor antibodies were positive. Brain MRI showed bilateral orbital involvement due to dysthyroidism in the context of Graves’ disease. The patient received corticosteroid associated with the etiological treatment. Outcome was favorable with regression of ocular symptoms after few days of treatment.

Conclusion: Graves’ orbitopathy is the most frequent extrathyroid complication in Graves’ disease. Natural history, described by Rundle, features an initial inflammatory or active phase in which acute episodes and spontaneous remissions alternate, then a fibrotic phase, with regression within 12–18 months. Diagnosis is based on symptoms and ocular signs. Clinical examination must therefore be rigorous; in case of doubt, the ophthalmologist’s opinion is determining. Various classifications assess clinical signs: most widely used are the EUGOGO (European Group Of Graves’ Orbitopathy). MRI imaging is essential to assess the degree of severity, in correlation with clinical involvement. Intravenous glucocorticoids are recommended in moderately severe and active OT. This condition affects the quality of life of patients and requires multidisciplinary care.