Endocrine Abstracts

Introduction: Graves’ orbitopathy is an inflammatory autoimmune disorder. It is the most common extrathyroidal manifestation of Graves’ disease and it is the leading cause of proptosis in adults. We report 3 cases of Graves’ orbitopathy in order to detail ocular manifestations and protocol management in this disease.

Observation 1: A 63-year-old woman was referred for left conjunctival redness. The best-corrected visual acuity was 10/10 in the right eye and 6/10 in the left eye. Examination showed von Graves’ sign, bilateral proptosis, and eyelid retraction. Slit lamp examination revealed left conjunctival hyperemia and superficial punctuate keratitis. Elevated levels of thyroid hormones and the presence of anti-TSH receptor antibodies confirm the diagnosis of moderate Graves’ orbitopathy.

Observation 2: A 52-year-old woman presented with orbital pain with eye movement. Ophthalmological examination revealed bilateral proptosis mainly affecting the left eye, restriction of eye movements, left relative afferent pupillary defect and high left intra-ocular pressure. Brain MRI showed bilateral orbital involvement extraocular muscle enlargement and left optic nerve sheath infiltration. The diagnosis of severe Graves’ orbitopathy with dysthroid optic neuropathy was established. The patient received 500 mg intravenous methylprednisolone /week for 6 weeks with a good response.

Observation 3: A 16-year-old woman with a history of Grave’s disease since 2 months was referred for bilateral eyelid swelling. Ophthalmological examination revealed best-corrected visual acuity of 8/10, ophthalmoplegia, bilateral conjunctival hyperemia with swelling of caruncle. The patient was treated with corticosteroids 60 mg/day with complete restoration of the eye motility.

Discussion: The most common clinical signs of Graves’ orbitopathy are proptosis, upper eyelid retraction, oculomotor disorders, and ocular inflammatory signs such as conjunctival hyperemia, and caruncle swelling. Optic neuropathy and corneal ulceration are the most vision-threatening complications. Clinical examination allows assessing the activity and severity of the disease on the basis of predefined scores. Computerized tomographic and magnetic resonance imaging are both useful in establishing the diagnosis and in evaluating the severity of orbital damage. The management of moderate and severe Graves’orbitopathy is based on local treatment and intravenous glucocorticosteroids. Immunosuppression therapy is administered in cases of resistance to corticosteroids.