Article

Diagnosis and management of thyroid orbitopathy

Department of Ophthalmology and Visual Sciences, University of Wisconsin–Madison, Madison, Wisconsin, United States
Otolaryngologic Clinics of North America (Impact Factor: 1.34). 11/2005; 38(5):1043-74. DOI: 10.1016/j.otc.2005.03.015
Source: PubMed

ABSTRACT Thyroid orbitopathy, also known as Graves' orbitopathy, is an autoimmune orbital disease characterized by abnormal percentages of peripheral blood suppressor/cytotoxic T8+ lymphocytes, and a depressed T4/T8 ratio. Environmental and genetic factors, such as HLA-DR histocompatibility loci, may play a role in developing thyroid orbitopathy, although a specific cause has not yet been undetermined. Both cellular and humoral immune mechanisms contribute to the disorder.

0 Followers
 · 
188 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the efficacy and safety of repeated subconjunctival injections of triamcinolone in the treatment of upper-lid retraction with thyroid-associated ophthalmopathy. Interventional controlled retrospective clinical study. We studied 23 eyes in 15 patients as the nontreatment control group and 35 eyes in 21 patients as the treatment group. In the treatment group, triamcinolone acetonide was subconjunctivally injected into each lid as 4 doses of 20 mg at 1-month intervals. After the treatment, the eyes were divided into 2 groups, response and nonresponse, based on the improvement in margin reflex distance. The eyes of the nontreatment group received no medicine. The eyes were examined regularly. The rate of spontaneous improvement in the nontreatment group was 17.4%. The mean rate of effectiveness was 68.6%. The improvement of upper-lid retraction was 2.31 mm (0 to 7 mm). The margin reflex distance was significantly smaller at 1 month after the initiation of treatment. Mean lid retraction time before treatment was 4.58 months in the response group versus 9.91 months in the nonresponse group. In the eyes presenting upper-lid retraction up to 6 months before treatment was initiated, the response rate was 83.3%. The response rate was only 36.4% when lid retraction developed more than 6 months before the procedure. The muscle thickness of the levator/superior rectus complex was significantly reduced after treatment in the response group (5.13 ± 0.85 mm at last follow-up vs. 5.69 ± 0.93 mm at baseline). Repeated subconjunctival injection of triamcinolone is an effective and safe treatment for upper-lid retraction due to thyroid-associated ophthalmopathy.
    Canadian Journal of Ophthalmology 02/2012; 47(1):34-41. DOI:10.1016/j.jcjo.2011.12.005 · 1.30 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Thyroid eye disease (TED) is the most common cause of orbital disease in adults. The immunologic pathogenesis of TED has been an area of active research and considerable progress has resulted in an expansion of therapeutic options. Although surgical intervention may be required, a majority of TED patients can be managed with medical therapies. Of medical therapies, glucocorticoids remain the agent of choice in the control of TED activity. The objective of this review is to discuss the paradigm and options in medical management of TED.
    Saudi Journal of Ophthalmology 01/2011; 25(1):3-13. DOI:10.1016/j.sjopt.2010.10.001
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine the outcomes of orbital surgical decompression in patients affected by thyroid orbitopathy with mild-to-severe proptosis. The surgical procedures included fat removal alone or combined with orbital bone walls fracture. An analysis of a retrospective case series of 56 patients (115 orbits) who underwent orbital decompression for Graves' orbitopathy between July 1997 and September 2006 using different surgical techniques: orbital fat decompression alone or combined with bone decompression via coronal, trans-palpebral or trans-nasal access; the endoscopic trans-nasal access for medial orbital wall decompression associated with fat removal has been the procedure of choice in the last 5 years. The mean proptosis reduction was 3.40 mm (0-8 mm) by fat removal and 5.40 mm (1-10 mm) by fat removal and bone decompression combined. The association of both procedures reduces the amount of fat to be removed, avoiding enophthalmos and thus decreasing the number of orbital walls to be fractured. The incidence of new-onset primary-gaze diplopia was 38%. Most of the patients subsequently underwent eyelid surgery to reduce retraction and to achieve symmetry. Orbital decompression is effective in reducing proptosis, exposure keratopathy and congestive apex symptoms, and in improving cosmesis. Endoscopic nasal decompression combined with orbital fat removal allows a precise and gradual medial and infero-medial wall decompression; it permits a less aggressive approach to the bone orbital decompression on the whole. In any case, surgical procedures need to be tailored to the individual patient, knowing that further operations are essential to improve cosmetic results after proptosis correction.
    Journal of Plastic Reconstructive & Aesthetic Surgery 12/2008; 63(2):240-6. DOI:10.1016/j.bjps.2008.09.017 · 1.47 Impact Factor