Endocrine Abstracts

Introduction: Dysthyroid ophthalmopathy corresponds to eye damage encountered in various thyroid diseases. It is seen mainly in Graves’ disease, and may develop any time in the course of the disease evolution. Clinical presentations of Graves’ ophtalmopathy (GO) are extremely heterogeneous. GO may be sight threatening in 3–5% of cases, and then represent an emergency requiring immediate treatment. We report three cases illustrating a particular   presentation of these orbitopathies.

Observation 1: A 61 years old man, followed for 1 year for Graves’ disease (GD) with Carbimazole 10 mg / day, presents for 4 months bilateral exophtalmopathy with lid retraction predominant at the left eye, associated with retroorbital pain. Clinical examination found a homogeneous goiter grade 1. Visual acuity was to hand movements on the right and light perception on the left. He had an important chemosis, Mourits score at 7/10 for left and 5/10 right. The patient had corneal abscess having evolved under intravenous antibiotics. For orbitopathy, our patient received three consecutive boluses of methylprednisolone 1 g daily , then 6 weekly bolus of 500 mg  then 250 mg  for 6 more weeks with a good evolution.

Observation 2: A 41 years old man, who had a total thyroidectomy 1 month ago for GD, with hormonal replacement. He presents since 5 months an exophthalmopathy with inocclusion of the left eye. He had an opaque cornea with significant chemosis, quoted 7/10 according to Mourits score. Patient was received intravenous corticosteroids: 3 daily bolus of methylprednisolone 1 g / day, then 500 mg / week for 6 weeks and 250 mg /week for 6 weeks. The outcome was favorable, with persistent corneal opacity.

Observation 3: A 70 years old woman, followed for 3 years for multinodular goiter which progress like GD. She was treated by Carbimazole. She presented for 1 month a bilateral exophthalmopathy with eyelid and conjunctival edema. She had a grade 2 goiter with two nodules, respectively measuring 1 to 2 cm. Visual acuity was reduced with chemosis and conjunctival hyperemia. Our patient received 12 bolus of injectable steroids: 500 mg /week for 6 weeks  then 250 mg/ week with good evolution.

Conclusion: GO is a complex inflammatory disorder that is better managed by a multidisciplinary team.  An appropriate assessment of both severity and activity of the disease warrants an adequate treatment. Intravenous glucocorticoids remain the treatment of choice for active moderate to severe disease.