Endocrine Abstracts

Introduction

Graves ophthalmopathy (GO) is an inflammatory autoimmune disorder of the orbit which is associated with autoimmune thyroid disease. The medical treatment of severe and sight threatening GO remains a challenge, it generally implies the use of glucocorticoids with others treatments. Mycophenolate mofetil (MMF) is a prodrug of mycophenolic acid that prevents T-cell and B-cell proliferation and the production of cytotoxic T-cells and antibodies. Furthermore, an antiproliferative effect on orbital target cells has also been considered. We report the case of a patient presenting with sight threatening GO treated with glucocorticoids and MMF.

Case presentation

A 44-year-old man with hypertension, presented since November 2019 Graves’ disease diagnosed following the onset of bilateral proptosis. The evolution was marked by the worsening of his ophtalmopathy in July 2020. Emergency ophthalmological examination showed a visual acuity at 7/10 on the right eye and < 1/10 on the left eye, superficial punctate keratitis in both eyes, lazy photomotor reflex and slight papillary pallor in the nasal area of the left eye, limitation of the abduction and the presence of inflammatory signs in both eyes more accentuated on the left eye. Orbital MRI showed Graves’ orbitopathy with bilateral exophthalmia grade III with greater compression of optic nerve on the left eye. The patient received methylprednisolone intravenously for three days (1 g/day) followed by oral corticosteroid therapy at a dose of 1 mg/Kg/day with improvement in inflammatory signs without improvement in visual acuity. The management was to combine mycophenolate mofetil at a dose of 1 g*3/day. The outcomes were favorable with resumption of vision on the left eye (8/10) and improvement of the visual acuity on the right eye (10/10) without serious adverse events.

Conclusion

The combination of MMF and glucocorticoids seem to be promising since it shows beneficial effect in sight threatening Graves’ orbitopathy without major toxicities.