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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

Orbital computed tomography images showing enlarged inferior and medial rectus muscles in a patient with thyroid-associated ophthalmopathy. The inferior rectus muscle is enlarged, mimicing an orbital tumor
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f3: Orbital computed tomography images showing enlarged inferior and medial rectus muscles in a patient with thyroid-associated ophthalmopathy. The inferior rectus muscle is enlarged, mimicing an orbital tumor

Mentions: Eye movements are restricted due to edema that occurs in the extraocular muscles during the infiltrative stage and the subsequent fibrosis. Diplopia manifesting as the appearance of overlapping images is common. In primary and reading positions, it affects daily activities and causes patients significant discomfort. Despite expansion of the extraocular muscles in TAO, the muscle fibers themselves are normal. Muscle enlargement occurs due to separation of the muscle fibrils by fluid and fat deposits and by GAG material, fibrosis, scar formation, and leukocyte infiltration. Usually a single muscle is involved. While any of the six extraocular muscles may be involved, enlargement of the inferior rectus muscle is seen in most patients (Figure 3), followed by medial and superior rectus muscle involvement (Figure 4).32 Pressure exerted by a fibrotic inferior rectus muscle on the globe may cause a spike in intraocular pressure during upgaze. In some cases, extraocular muscle fibrosis may also be associated with chronically elevated intraocular pressure.33


Thyroid-associated Ophthalmopathy
Orbital computed tomography images showing enlarged inferior and medial rectus muscles in a patient with thyroid-associated ophthalmopathy. The inferior rectus muscle is enlarged, mimicing an orbital tumor
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f3: Orbital computed tomography images showing enlarged inferior and medial rectus muscles in a patient with thyroid-associated ophthalmopathy. The inferior rectus muscle is enlarged, mimicing an orbital tumor
Mentions: Eye movements are restricted due to edema that occurs in the extraocular muscles during the infiltrative stage and the subsequent fibrosis. Diplopia manifesting as the appearance of overlapping images is common. In primary and reading positions, it affects daily activities and causes patients significant discomfort. Despite expansion of the extraocular muscles in TAO, the muscle fibers themselves are normal. Muscle enlargement occurs due to separation of the muscle fibrils by fluid and fat deposits and by GAG material, fibrosis, scar formation, and leukocyte infiltration. Usually a single muscle is involved. While any of the six extraocular muscles may be involved, enlargement of the inferior rectus muscle is seen in most patients (Figure 3), followed by medial and superior rectus muscle involvement (Figure 4).32 Pressure exerted by a fibrotic inferior rectus muscle on the globe may cause a spike in intraocular pressure during upgaze. In some cases, extraocular muscle fibrosis may also be associated with chronically elevated intraocular pressure.33

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