Thyroid orbitopathy (aka Thyroid Ophthalmopathy or Graves 'Ophthalmopathy) is one of the main symptoms of Graves' disease and can damage your eyesight. What are the causes and symptoms of thyroid ophthalmopathy? How is this orbitopathy treated? Does Graves' ophthalmopathy always lead to eye damage?

Thyroid Orbitopathy(akaThyroid Ophthalmopathy ,Graves Ophthalmopathy ) is a symptom complex on the part of the eyes, caused by immune inflammation of the soft tissues of the orbit in the course of Graves' disease (30% of patients with ChGB). The disease may lead to temporary or permanent eye damage.

Thyroid orbitopathy is often one of the symptoms of Graves' disease, and is also the only symptom of this disease.

Orbitopathy most often appears simultaneously with the onset of hyperthyroidism or up to 18 months after the onset of the disease (70%).

Rarely, ocular symptoms develop before the onset of thyroid disease (25% of patients). Thyroid orbitopathy may, but is very rare (5%), occur with or without underlying Graves' disease.

What is Graves' disease and how does it manifest itself?

Graves' disease is an autoimmune disease in which autoantibodies against the TSH receptor (anti-TSHR antibodies) appear.

The disease is the result of the interaction of many components, incl. such as:

  • genetic predisposition (disease in>50% of cases occurs in families)
  • smoking, stress
  • estrogens (more common in women and after childbirth)

As a result of the above-mentioned factors, the immune supervision in the patient's body is disturbed and the formation of autoantibodies, which by binding with TSH receptors, causes their excessive activation and increased secretion of hormones, and the formation of symptoms of hyperthyroidism.

Excess thyroid hormones inhibit the secretion of TSH by the pituitary gland, therefore laboratory tests show an increase in free thyroid hormones with a decrease in serum TSH concentration.

Among other symptoms of Graves' diseasethere is a characteristic pre-shin edema caused by autoimmune skin inflammation (it occurs rarely, in 3% of patients). In the elderly, cardiac symptoms are of the greatest importance:

  • atrial fibrillation
  • exacerbation of ischemic heart disease
  • worsening of heart failure

Sometimes a vascular goiter appears, which makes it easier to diagnose the disease.

Goitre in the course of thyroid diseases: types

Thyroid acropathy, another characteristic, albeit rare, symptom is the thickening and rounding of the distal phalanges of the hands.

Thyroid orbitopathy: how is it formed?

Against the TSH receptor on orbital fibroblasts, the cellular response is activated, followed by the activation of lymphocytes, the secretion of inflammatory cytokines, the proliferation of fibroblasts and the production of glycosaminoglycans.

These factors lead to swelling of the oculomotor muscles, as a result of which the intraorbital pressure increases, the eyeballs may move forward (malignant exophthalmos - severe cases of progressive infiltrative-edema orbitopathy) and obstruction of the venous outflow from the orbit.

Conjunctival hyperaemia and sometimes eyelid edema appear, which in turn causes eyelid regurgitation and corneal ulceration. The most dangerous complication is pressure on the optic nerve.

Over time, the inflammatory response dies out, and there is steatosis and fibrosis of the infiltrated tissues. It causes permanent changes and pressure and permanently impairs the mobility of the eyeball.

The disease is usually bilateral, sometimes the intensity of the changes is asymmetrical in both eyes. Unilateral thyroid orbitopathy is very rare.

Thyroid orbitopathy: symptoms

The first of all, the patient complains of troublesome photophobia and lacrimation, pain in the eyeballs and double vision. In addition to the noticeable restriction of the movement of the eyeballs, the aforementioned inflammation and ulceration of the cornea may appear - these symptoms seriously threaten with blindness.

Thyroid Orbitopathy: Treatment

Thyroid orbitopathy, if mild, may self-extinguish without permanent sequelae. Usually, effective treatment of hyperthyroidism is then sufficient, which may result in remission of orbitopathy within 2-3 months.

There is a high risk of permanent eye damage or total blindness if there is significant exophthalmia, obvious soft tissue and muscle involvement, corneal involvement, or visual impairment. In such a situationspecialist treatment is necessary, along with effective treatment of the underlying disease.

Anti-inflammatory treatment with intravenous glucocorticosteroids is then applied (pulses of methylprednisolone, initially in a high dose, then gradually reduced), still in the phase of active inflammation.

Irradiation of the eye sockets is used as a supplementary method. Surgical treatment is necessary in case of permanent consequences, it usually consists of multi-stage orbital decompensation, strabismus treatment, eyelid surgery.

If, despite the use of steroid therapy, the patient does not improve for 1-2 weeks and there is a risk of blindness loss, surgical decompensation of the orbit is considered. It is important to have topical treatment at the same time to prevent corneal ulceration.

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