Thyroid-associated Ophthalmopathy

Abstract

Thyroid-associated ophthalmopathy is the most frequent extrathyroidal involvement of Graves’ disease but it sometimes occurs ineuthyroid or hypothyroid patients. Thyroid-associated ophthalmopathy is an autoimmune disorder, but its pathogenesis is not completelyunderstood. 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-associatedophthalmopathy are soft tissue involvement, eyelid retraction, proptosis, compressive optic neuropathy, and restrictive myopathy. Toassess the activity of the ophthalmopathy and response to treatment, clinical activity score, which includes manifestations reflectinginflammatory changes, can be used. Supportive approaches can control symptoms and signs in mild cases. In severe active disease, systemicsteroid 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 andanticytokine therapies have been used in patients who are resistant to conventional treatments. Rehabilitative surgeries are often neededafter treatment.