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Thyroid-associated Ophthalmopathy

View Article: PubMed Central - PubMed

ABSTRACT

Thyroid-associated ophthalmopathy is the most frequent extrathyroidal involvement of Graves’ disease but it sometimes occurs in euthyroid or hypothyroid patients. Thyroid-associated ophthalmopathy is an autoimmune disorder, but its pathogenesis is not completely understood. Autoimmunity against putative antigens shared by the thyroid and the orbit plays a role in the pathogenesis of disease. There is an increased volume of extraocular muscles, orbital connective and adipose tissues. Clinical findings of thyroid-associated ophthalmopathy are soft tissue involvement, eyelid retraction, proptosis, compressive optic neuropathy, and restrictive myopathy. To assess the activity of the ophthalmopathy and response to treatment, clinical activity score, which includes manifestations reflecting inflammatory changes, can be used. Supportive approaches can control symptoms and signs in mild cases. In severe active disease, systemic steroid and/or orbital radiotherapy are the main treatments. In inactive disease with proptosis, orbital decompression can be preferred. Miscellaneous treatments such as immunosuppressive drugs, somatostatin analogs, plasmapheresis, intravenous immunoglobulins and anticytokine therapies have been used in patients who are resistant to conventional treatments. Rehabilitative surgeries are often needed after treatment.

No MeSH data available.


Related in: MedlinePlus

Right upper lid retraction in a 38-year-old male patient. Upper lid retraction (Dalrymple’s sign) may be one of the initial signs of thyroid-associated ophthalmopathy
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f1: Right upper lid retraction in a 38-year-old male patient. Upper lid retraction (Dalrymple’s sign) may be one of the initial signs of thyroid-associated ophthalmopathy

Mentions: Upper eyelid retraction (Dalrymple’s sign) may emerge as an early sign of TAO. Upper eyelid retraction in TAO may be caused by increased sympathetic stimulation of Müller’s muscle by thyroid hormone, but may also be attributed to the formation of scar tissue between the levator muscle and surrounding tissues, or to overaction of the levator muscle contracting against a tight inferior rectus muscle (Figure 1).29 In addition to upper eyelid retraction, upper eyelid lag (von Graefe’s sign) is also an important sign. Upper eyelid lag refers to a delay in the upper eyelid following as the eye rotates downward as a patient tracks an moving object. This is also an important criterion in the early diagnosis of TAO.


Thyroid-associated Ophthalmopathy
Right upper lid retraction in a 38-year-old male patient. Upper lid retraction (Dalrymple’s sign) may be one of the initial signs of thyroid-associated ophthalmopathy
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5384127&req=5

f1: Right upper lid retraction in a 38-year-old male patient. Upper lid retraction (Dalrymple’s sign) may be one of the initial signs of thyroid-associated ophthalmopathy
Mentions: Upper eyelid retraction (Dalrymple’s sign) may emerge as an early sign of TAO. Upper eyelid retraction in TAO may be caused by increased sympathetic stimulation of Müller’s muscle by thyroid hormone, but may also be attributed to the formation of scar tissue between the levator muscle and surrounding tissues, or to overaction of the levator muscle contracting against a tight inferior rectus muscle (Figure 1).29 In addition to upper eyelid retraction, upper eyelid lag (von Graefe’s sign) is also an important sign. Upper eyelid lag refers to a delay in the upper eyelid following as the eye rotates downward as a patient tracks an moving object. This is also an important criterion in the early diagnosis of TAO.

View Article: PubMed Central - PubMed

ABSTRACT

Thyroid-associated ophthalmopathy is the most frequent extrathyroidal involvement of Graves’ disease but it sometimes occurs in euthyroid or hypothyroid patients. Thyroid-associated ophthalmopathy is an autoimmune disorder, but its pathogenesis is not completely understood. Autoimmunity against putative antigens shared by the thyroid and the orbit plays a role in the pathogenesis of disease. There is an increased volume of extraocular muscles, orbital connective and adipose tissues. Clinical findings of thyroid-associated ophthalmopathy are soft tissue involvement, eyelid retraction, proptosis, compressive optic neuropathy, and restrictive myopathy. To assess the activity of the ophthalmopathy and response to treatment, clinical activity score, which includes manifestations reflecting inflammatory changes, can be used. Supportive approaches can control symptoms and signs in mild cases. In severe active disease, systemic steroid and/or orbital radiotherapy are the main treatments. In inactive disease with proptosis, orbital decompression can be preferred. Miscellaneous treatments such as immunosuppressive drugs, somatostatin analogs, plasmapheresis, intravenous immunoglobulins and anticytokine therapies have been used in patients who are resistant to conventional treatments. Rehabilitative surgeries are often needed after treatment.

No MeSH data available.


Related in: MedlinePlus