Endocrine Abstracts

Thyroid orbitopathy (TO) is an autoimmune inflammatory disease of retroocular tissues. Mostly, TO is associated with Graves’ hyperthyroidism. The development of TO is accompanied by pathological changes in the soft tissues of the orbit with damage to the optic nerve and cornea, the accessory apparatus of the eye. Despite the presence of specific symptoms, the diagnosis of TO causes problems for doctors. A 61-year-old man complained of discomfort in the eyes, double vision, lacrimation, dryness and redness of the eyes, swelling under the eyes, palpitations, which first appeared in June 2020. At first, the patient did not go to the doctor, but decided to do an MRI of the orbit, which revealed a thickening of the lower and internal oblique muscles of the eye, more pronounced on the left, bilateral exophthalmos, edema of the lower eyelid on the left, expansion of the sheathing spaces of the optic nerves. The patient consulted an ophthalmologist after a sharp decrease in visual acuity in the right eye (diagnosis: embolism of the central retinal artery of the right eye, treatment without a pronounced positive effect, subclinical thyrotoxicosis was additionally revealed). The patient was referred to an endocrinologist, who diagnosed obesity, prescribed a diet and examination (results: TSH-0.02 mIU/ml, T4-15.76 pmol/l, T3-8.59 pmol/l). In September 2020, an ophthalmologist diagnosed the patient with reactive edema of unknown etiology in both eyes. In parallel, the patient is monitored by an endocrinologist and undergoes another additional examination: ultrasound of the thyroid gland (an increase in the volume of the thyroid gland with diffuse changes, an increase in the cervical lymph nodes), an increased titer of antibodies to TSH receptors (16.05 IU/l) was detected. However, the diagnosis was not changed, no treatment was prescribed. On physical examination: HR-98 beats per minute, the presence of spontaneous retrobulbar pain, redness and edema of the eyelids, conjunctival injection, redness and edema of the lunate fold, lacrimal meatus, chemosis. The patient was diagnosed with Grave`s disease, which was complicated by TO in both eyes, active stage, CAS 6 points. Thyroidectomy was recommended for the patient, Tyrosol 30 mg per day was prescribed, pulse therapy with Prednisolone was performed. Thus, we can say that thyroid orbitopathy is a multidisciplinary problem that requires closer interaction of ophthalmologists and endocrinologists, which will lead to early diagnosis and timely prescribed treatment, which, in turn, will improve the prognosis and quality of life of patients.