Endocrine Abstracts

Introduction: Graves’ disease is a common autoimmune disease that can be complicated by orbital damage sometimes threatening the visual prognosis. We report the case of a patient with Graves’ orbitopathy and we discuss the difficulties of clinical evaluation and therapeutic management.

Case report: A 68-year-old woman presented to our department complaining of eye protrusion and progressive vision reduction in both eyes. She has had a history of Graves’ disease, treated with synthetic antithyroid drugs for 1 year, then thyroidectomy. The ophthalmological examination revealed in the right eye a visual acuity at 1/10, a proptosis, intraocular pressure (IOP) at 20 mmHg, a limitation of abduction, a dense cataract with a pale optic disc at the fundus. In the left eye, visual acuity was at 3/10; there was a proptosis, IOP at 22 mmHg, a mild cataract with optic disc hyperaemia at the fundus. We completed with an orbital MRI and a thyroid assessment. The patient was put on hypotonic eye drops and received bolus of intravenous corticosteroids. The evolution was marked by an improvement in oculomotricity and a partial regression of proptosis and IOP. Given the persistence of the threat to the visual prognosis, orbital decompression surgery was indicated.

Discussion: The diagnosis of dysthyroid orbitopathy is often obvious. The clinical evaluation must specify the evolutionary stage (clinical activity score) and the gravity or severity according to the classification of the European group EUGOGO. It is important to recognize the 3 major stages of the disease: diagnosis with an ophthalmological and thyroid evaluation, the activity phase which may or not require specific treatment, and the sequelae phase after 6 months of stability and inactivity. Initially, rapid restoration of euthyroidism, smoking cessation and simple ophthalmological symptomatic treatment are proposed. In the event of advanced and active dysthyroid orbitopathy, oral or intravenous corticosteroid therapy associated or not with orbital radiotherapy. The place of emergency decompressive surgery in cases of optic neuropathy is controversial.

Conclusion: Dysthyroid orbitopathy is a complex pathology whose management is often difficult. A multidisciplinary management is recommended in order to allow an adequate biological, clinical and radiological evaluation and to propose an adequate treatment.