Thyroid Ophthalmopathy

John P. Christodouleas and Roland Engel

Background

What causes thyroid ophthalmopathy (TO)?

T-cell lymphocytic infiltration of orbital and periorbital tissues (secondary to autoimmune antibody–mediated reaction against the TSH receptor)

Name 2 conditions associated with TO.

Graves Dz and Hashimoto thyroiditis are both associated with TO.

What is the end result of untreated TO?

Untreated TO will lead to fibrosis, which develops over the course of 2–5 yrs.

What are the signs/Sx of TO?

Exophthalmos, impaired extraocular movements/diplopia, periorbital edema, and lid retraction. In severe cases, compression of the optic nerves and decreased visual acuity can occur.

Workup/Staging

What does the general workup of TO include?

TO workup: H&P (Hertel exophthalmometer), CBC, CMP, TFTs, and CT/MRI orbit

What is the staging/risk stratification?

There is no formal staging/risk stratification. Studies have grouped pts into mild, moderately severe, and severe TO, though the exact definition of these terms varies between studies.

Treatment/Prognosis

What is the general Tx paradigm for TO?

TO Tx paradigm: Treat underlying disorder. For mild Dz, consider observation vs. RT; for moderately severe Dz, consider high-dose steroids vs. RT; and for severe Dz, perform orbital decompression surgery (e.g., for acute visual acuity or color perception changes).

RT should be initiated within how many mos from onset of TO?

RT should be initiated within 7 mos

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