Graves ophthalmopathy british journal of ophthalmology. Pdf graves ophthalmopathy go is an autoimmune disorder of the orbit that is clinically relevant in 2550% of. However, studies by several groups have begun to unravel the many complex factors contributing to development of these ocular and dermal manifestations of graves disease. Graves disease is often characterized by ocular manifestations of autoimmune origin, socalled graves orbitopathy or ophthalmopathy. Dickinson,3 anja eckstein,4 pat kendalltaylor,5 claudio marcocci,6 maarten p. In this study, the therapeutic benefit of rt was evaluated in terms of patients. The influence of juvenile graves ophthalmopathy on graves. Orbital radiation therapy for graves ophthalmopathy.
Jul 09, 2004 graves ophthalmopathy is clinically relevant in approximately 50% of patients with graves disease, severe forms affecting 3%5% of patients. Therefore, tethering effect from restricted extraocular muscles may be negligible in the origin of corneal astigmatism in graves ophthalmopathy. Graves ophthalmopathy is the most common extrathyroid manifestation in patients with graves disease, based on inflammatory and autoimmune conditions in. Clinical criteriaforthe assessment of disease graves. The eyelids may be retracted upward, making it seem as though the person is constantly staring. A 55yearold man with a history of graves disease treated with radioactive iodine and graves ophthalmopathy was referred to our dermatology clinic by his endocrinologist with a 2year history of severe pretibial myxedema pm that had failed treatment with systemic immunosuppressants after diagnosis by an outside dermatologist in the united kingdom approximately 2 years prior.
Pdf orbital radiation for graves ophthalmopathy david. Graves orbitopathy go is the main extrathyroidal manifestation of graves disease, though severe forms are rare. In contrast, the pathophysiology of graves ophthalmopathy go and thyroidassociated pretibial dermopathy ptd is less well understood. Corrected for the ethnic factor the increased risk from smoking for europeans was 24 112518, 95% confidence interval times higher. The defining characteristic of this condition is the protrusion of the eyes exophthalmos. The overall risk for europeans for developing graves ophthalmopathy was 64 178227 confidence interval times higher than for asians. Endocrine ophthalmopathy an overview sciencedirect topics. About 40% of patients who have graves ophthalmopathy smoke, and smoking is a wellestablished risk factor for developing graves ophthalmopathy odds ratio 7. Patients with graves disease, an autoimmune disorder that typically affects the thyroid gland, may also experience graves eye disease, or graves ophthalmopathy as its also known, which causes bulging eyes and the doubling of vision due to the. The thyroid is a small, butterflyshaped gland in the front of your neck. In recent years, immunosuppressive therapy, as an alternative to corticosteroids, has been. Graves ophthalmopathy go significantly impairs the quality of life of affected individuals and the most severe cases can be sight threatening. Graves ophthalmopathy, also called graves orbitopathy, is a potentially sightthreatening ocular disease that has puzzled physicians and scientists for nearly two centuries.
Pdf graves ophthalmopathy go, an autoimmune condition associated with graves disease gd, occurs at a. Graves ophthalmopathy in relation to cigarette smoking and. Fortunately, only about 5% of those suffering from this disease. On imaging, it is characterized by bilateral and symmetrical enlargement of the extraocular muscle bellies.
The evaluation and treatment of graves ophthalmopathy. Graves ophthalmopathy go is an eye disorder encountered exclusively in autoimmune thyroid diseases, most commonly graves disease. Graves orbitopathy ophthalmopathy is an autoimmune disease of the retroorbital tissues. Thyroidassociated ophthalmopathy taoa, aka thyroid eye disease or graves ophthalmopathy refers to several ocular manifestations related to the systemic. Graves ophthalmopathy, also known as graves orbitopathy or thyroidassociated ophthalmopathy, is an ophthalmic disorder with potential to cause vision loss. Thyroidassociated orbitopathy or thyroidassociated ophthalmopathy is the most common cause of proptosis in adults and is most frequently associated with graves disease. Interestingly, ophthalmopathy is not directly correlated to thyroid function but it is greatly associated with graves disease itself. Practical guidelines management of graves ophthalmopathy. Thyroid hormones control how your body uses energy, so. Update on thyroidassociated ophthalmopathy with a special. We studied 90 patients with graves ophthalmopathy and graves hyperthyroidism in whom severity of graves ophthalmopathy and thyroid function regardless of antithyroid treatment were assessed when referred to our institution.
Many patients require rehabilitative surgery, such as orbital decompression and lipectomy, to restore function and appearance. About 40% of patients who have graves ophthalmopathy smoke, and smoking is a wellestablished risk factor for developing graves ophthalmopathy odds ratio. Graves ophthalmopathy go is an autoimmune condition primarily managed with prolonged courses of glucocorticoids, which can be associated with significant side effects. Graves ophthalmopathy an overview sciencedirect topics. Graves ophthalmopathy, also called graves orbitopathy, is a potentially sightthreatening ocular disease. Graves disease is an autoimmune disorder that causes hyperthyroidism, or overactive thyroid. Two age peaks of incidence are observed in the fifth and seventh decades of life, with slight differences between women and men. The disorder generally occurs in patients with graves hyperthyroidism, or a history thereof, but can also occur in euthyroid patients without a history of thyroid disease or in hypothyroid patients with hashimotos thyroiditis. There were analyzed data visual acuity, proptosis, palpebral fissure measurements, clinical activity score cas, and the course of gd of 67 children who have been newly diagnosed with gd. Diagnostic criteria for graves ophthalmopathy sciencedirect. Consensus statement of the european group on graves orbitopathy eugogo on management of graves orbitopathy luigi bartalena,1 lelio baldeschi,2 alison j. It usually appears at the same time as hyperthyroidism, and is characterized by proptosis exophthalmos, periorbital and conjunctival edema, eye muscle dysfunction, and on occasion corneal ulceration or optic neuropathy. Oct 15, 2014 patients with graves disease, an autoimmune disorder that typically affects the thyroid gland, may also experience graves eye disease, or graves ophthalmopathy as its also known, which causes bulging eyes and the doubling of vision due to the disease attacking the muscles surrounding the eyes. Several clinical variants of go exist, including euthyroid go, recently listed as a.
Advances in treatment of active, moderatetosevere graves. Graves orbitopathy is a condition associated with swelling of the tissue in the orbit, creating bulging of the eyes. The diagnosis of graves orbitopathy is made by an ophthalmologist. Given the limited therapeutic options, a strong emphasis should be placed on disease prevention to diminish the significant morbidity associated with this disease. Graves ophthalmopathy is a constellation of findings, apparent in 25% to 50% of patients with graves disease, that results from edema and lymphocytic infiltration of orbital fat, connective tissue, and eye muscles. Despite important progress in understanding the pathophysiological mechanisms leading to the development of this disease in the orbits during the last decade, some important. Thyroidassociated orbitopathy tao, also known as thyroid eye disease or graves ophthalmopathy, is an autoimmune disease affecting the thyroid, orbits, and skin. Pseudofourth nerve palsies have been described with thyroid ophthalmopathy. In its severe expression it is a disfiguring and invalidating disease that profoundly influences and impairs the quality of life of affected individuals 2. Treatment of graves orbitopathy ophthalmopathy uptodate. Thyroidassociated ophthalmopathy is the commonest cause of proptosis in adults.
Feb 25, 2010 graves ophthalmopathy, also called graves orbitopathy, is a potentially sightthreatening ocular disease that has puzzled physicians and scientists for nearly two centuries. Graves disease eye disease graves disease is the only kind of hyperthyroidism that can be associated with inflammation of the eyes, swelling of the tissues around the eyes and bulging of the eyes called graves ophthalmopathy or orbitopathy. The aim of our study was to relate thyroid function to the severity of graves ophthalmopathy. Graves ophthalmopathy,also known as thyroid eye disease ted, is an autoimmune inflammatory disorder of the orbit and periorbital tissues, characterized by upper eyelid retraction, lid lag, swelling, redness erythema, conjunctivitis, and bulging eyes exophthalmos. Radiation retinopathy after orbital irradiation for graves. It is associated with graves disease, a condition that causes over activity of the thyroid gland the gland that sets the rate of metabolism in the body. Graves orbitopathy go is an autoimmune condition, which is associated with poor clinical outcomes including impaired quality of life and socioeconomic status.
Abstract forty patients with graves ophthalmopathy stages iiiv were divided into two groups in a random manner according to their year of birth. Graves ophthalmopathy also known as graves orbitopathy or thyroid eye disease occurs as a spectrum of disease ranging from subclinical enlargement of the extraocular muscles in most patients with this condition to disfiguring and visionthreatening involvement of the entire orbit in an unfortunate few. Mourits,7 petros perros,8 kostas boboridis,9 antonella boschi,10. With this disease, your immune system attacks the thyroid and causes it to make more thyroid hormone than your body needs. Graves ophthalmopathy is considered to be present if eyelid retraction occurs in association with objective evidence of thyroid dysfunction or abnormal regulation. Patients are not always hyperthyroid at presentation, and they may even be hypothyroid. Other articles where graves ophthalmopathy is discussed. Results in the intentiontotreat population, 29 of 42 patients who received.
Although esotropia is a more common finding with thyroid ophthalmopathy, convergence insufficiency has been described. Graves ophthalmopathy, also known as thyroidassociated ophthalmopathy tao, occurs in 2 to 7 % of patients with graves disease with the major manifestations being proptosis, ophthalmoplegia, optic neuropathy, andor eyelid retraction. Malfunctioning tsh receptors and immune cells within the eyes are major contributors to graves ophthalmopathy. Ophthalmopathy is an integral component of graves disease. Inferior rectus muscle restriction may mimic double elevator palsy. Risk factors for development or deterioration of graves. Thyroidassociated orbitopathy radiology reference article. Overall, a third of patients with graves disease develop some signs and symptoms of. Graves ophthalmopathy go, the most frequent extrathyroidal manifestation of graves disease, remains a pathogenetic enigma and a therapeutic dilemma. Graves ophthalmopathy is a chronic and multisystem disorder caused by an autoimmune process, characterized by the presence of antibodies that. Consensus statement of the european group on graves. In this study 26 consecutive patients with serious graves ophthalmopathy, defined as falling into nospecscategories 2c, 3b, 3c, 4b, 4c, 5a, 5b, 5c, or 6a, were treated with oral prednisone or cyclosporin for a period of 12 weeks. Graves eye disease, also called graves ophthalmopathy, is a problem that develops in people with an overactive thyroid caused by graves disease. Graves ophthalmopathy treatments medical clinical policy.
Graves ophthalmopathy definition of graves ophthalmopathy. Graves ophthalmopathy go is the main extrathyroidal manifestation of graves disease. The graves ophthalmopathy consists of all the pathological changes in orbital tissues, preceding, accompanying of following hyperthyroidism. The evaluation and treatment of graves ophthalmopathy ncbi. The first and only consumer book on thyroid eye disease by the author of graves disease, a practical guide this second printing of elaine moores meticulous, exhaustive and thoughtful book, is the definitive guide on thyroid eye disease ted, more specifically referred to as graves ophthalmopathy go. Some people might have a little redness and minor pain, while others have strong swelling, dryness, and more severe pain. Graves ophthalmopathy in patient with overt hypothyroidism. Effect of abnormal thyroid function on the severity of graves. To investigate juvenile graves ophthalmopathy go signs and compare graves disease gd course in patients with or without go. Recent reports indicate that orbital irradiation for graves ophthalmopathy is sometimes beneficial, particularly for dysthyroid optic neuropathy, and is not associated with serious complications. Graves ophthalmopathy is clinically relevant in approximately 50% of patients with graves disease, severe forms affecting 3%5% of patients.
Graves ophthalmopathy, like graves hyperthyroidism, is an autoimmune disease, but the mechanisms that. In its severe expression it is a disfiguring and invalidating disease that profoundly. Go may precede the onset of the thyroid dysfunction at times. We are aware, however, of four patients who were found to have radiation retinopathy after orbital irradiation for graves ophthalmopathy. Graves ophthalmopathy go is an inflammatory disorder of the orbit that occurs in association with autoimmune thyroid disease. Current evidence suggests that the incidence of go in europe may be declining, however data on the prevalence of this disease are sparse. Graves ophthalmopathy can cause a wide range of issues with your eyes. It occurs most commonly in individuals with graves disease, and less. Graves orbitopathy is an autoimmune process affecting the orbital tissues of patients with graves disease. Reality and perspectives luigi bartalena, aldo pinchera, and claudio marcocci dipartimento di endocrinologia e metabolismo, ortopedia e traumatologia, medicina del lavoro, university of pisa, 56124 pisa, italy abstract graves ophthalmopathy is an debilitating disease impairing the.1538 200 343 4 486 338 1510 1004 644 272 188 1387 998 296 1005 126 1123 455 1182 1610 22 912 853 1491 648 809 298 639 23 185 327 1439 83 762