Endocrine Abstracts

Introduction: Graves’ disease is rare but may be complicated by major eye signs of Graves’ series rarely causing paralysis of the optic nerve.

Aim: Report cases of seven patients collected between 1982 and 2013 presenting Graves’ disease complicated by optical neuropathy.

Observations: Men patients aged on average 44 years old (35–48), admitted for Graves’ disease complicated by ophthalmopathy with oculomotor paralysis. signs of eyes showed disease in three cases. Among other cases, neuropathy occurred during follow-up. They presented goiter Ib and II, nodular ultrasound in 4cases with signs of hyperthyroidism. The exophthalmia was averaged 20 mm for OG (18–22) and 22 mm (20–23) for the OD, not reducible with lid retraction. There was oculomotor paralysis with limitation of abduction and the adduction of the eye up and down and a diplopia. The fundus papillary showed pallor in all cases and the scanner orbital thickening internal muscle structures of the upper and lower extended their ocular insertion apex. the major thickening compressing the optic nerves.

The patients were put under solumedrol IV bolus followed by 1 mg/kg per day of Prednisone for 6 weeks and a maintenance of 10 mg/day dose for 6 months associated with Carbimazole for 2 years. The evolution of ophthalmia was spectacular with regression of oculomotor paralysis and exorbitism in a year and a half (1–3). All patients were in remission with a decrease of 8 years on average.

Discussion and conclusion: The Graves’ optic neuropathy is a rare and major complication. When the diagnosis and its management are late, patients are exposed to serious ocular sequelae. The particularity of our observations is the dramatic and relatively rapid regression of eye signs.