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.

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    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
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    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
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    ABSTRACT: The aim of this study was to present the authors' experience with identifi cation and classifi cation of thyroid ophtalmopathy activity. A total of 46 orbits from 23 patients with thyroid ophthalmopathy symptoms were evaluated on computed tomography images in terms of diameters and density of extraocular muscles, muscular index, proptosis, width of the optic nerve, width of superior ophthalmic vein and lacrimal gland position. Radiological symptoms of proptosis were present in 78.3% patients, while 80% cases of diagnosed proptosis were bilateral. The most frequently aff ected eye muscle was the inferior (61%) and medial (54%) rectus prior to superior (39%), lateral rectus (37%) and superior oblique (26%). The highest correlation between muscle enlargement and proptosis was noted in the case of inferior rectus (77%) and medial rectus (70%). 78% of muscle enlargement was bilateral. Anterior displacement of the lacrimal gland was observed in 58% of cases. Width of the superior ophthalmic vein and the optic nerve (sheath complex) did not diff er signifi cantly from normal population ranges. All muscles measured in the study had a lower density when compared to reference data; the density of the thickened muscles was lower than the density of muscles with an unmodifi ed diameter.