Endocrine Abstracts

Introduction: Grave’s orbitopathy (GO) is the main extra-thyroid manifestation of Graves’ disease (GD) and the leading cause of exophthalmia in adults. Its clinical presentation is extremely heterogeneous, ranging from mild ocular discomfort to sight-threatening disease. The aim of our study was to specify the clinical and paraclinical characteristics, as well as the therapeutic modalities of GO.

Patients and methods: Descriptive retrospective study in the period between September 2008-December 2018, including 45 patients followed for GO in Endocrinology-Diabetology department of the University Hospital of Casablanca.

Results: The average age was 45 years (19–70 years) with male predominance. The average duration of GD was 4.7 years (1 month–14 years). The GO appeared at the same time as the GD in 9 cases, before the GD in 2 cases, and after that in the rest of our patients. The time between GD and diagnosis of GO varied between 0 and 6 years. The GO was unilateral in 4 cases. GO was inactive in 33% of cases. Strabismus was noted in 6 patients, and associated with diplopia in 5 cases. Three of our patients had a complicated GO with a corneal abscess. According to the NOSPECS classification: the GO was classified as stage 1 in 27%, stage II in 25%, and stage III in 48% of cases. An orbital CT-scan was performed in 30 patients, and an MRI in 2 patients, who objected a GO grade I in 9 cases, grade II in 11 cases, and Grade III in 11 cases. The management of the GO was surgical in 3 cases, intravenous glucocorticoids in 32 cases. Selenium supplementation and general measures were the only treatment recommended in 10 patients.

Conclusion: Grave’s orbitopathy is more common in the male patient. The clinical expression is variable. The evaluation of the gravity and the activity of the GO as well as the radiological exploration allow a better management. Being considered an autoimmune disorder, corticosteroid therapy is widely used in severe and malignant forms.