ECE2022 Poster Presentations Thyroid (136 abstracts)
Added value for Graves’ orbitopathy management in a tertiary center – report of four cases
Inês Manique 1 , Sara Amaral 2 , Luísa Cortez 3 , Ana Palha 2 , Ana Duarte 4 & José Silva-Nunes 2
1Centro Hospitalar Universitário Lisboa Central, Endocrinologia, Diabetes e Metabolismo, Lisboa, Portugal; 1 Centro Hospitalar Universitário Lisboa Central, Endocrinologia, Diabetes e Metabolismo, Lisboa, Portugal; 3Centro Hospitalar Universitário Lisboa Central, Endocrinologia, Diabetes e Metabolismo, Portugal; 4Centro Hospitalar Universitário Lisboa Central, Oftalmologia, Lisboa, Portugal
Introduction: Graves orbitopathy is the major extrathyroidal manifestation of Graves Disease (GD). The approach depends on its clinical activity and severity. Treatment and referral to specialized centers, with Endocrinology and Ophthalmology, has a strong impact on the prognosis of Graves’ Disease (GD) and GO.
Cases report: We report four cases of DG with OG. Their characteristics and clinical evolution are shown in Table 1.
| Case 1 | Case 2 | Case 3 | Case 4 | ||
| Age (years old) | 39 | 42 | 44 | 47 | |
| Gender: | Female | Male | Female | Male | |
| Nationality: | Guinea-Bissau | Guinea-Bissau | Portugal | Portugal | |
| DG diagnosis | 2012 | 2016 | 2016 | 2018 | |
| Hyperthyroidism (Clinical/Biochemical) | Yes | Yes | Yes | Yes | |
| Initial TRAb (positive >1.5) | 2.8 U/l | 40 U/l | 21.6 U/l | 6.5 U/l | |
| GO: | Activity | Inactive | Active | Active | Active |
| Severity | Moderate/Severe | Moderate/Severe | Moderate/severe | Severe/sight-threatening (dysthyroid optic neuropathy) | |
| GD Medical therapy | Treatment | Thiamazole (Evacuated to Portugal in 2017 without therapy) | Thiamazole (Evacuated to Portugal in 2016 under thiamazole) | Thiamazole | Propylthiouracil |
| Maximum dose | 20 mg/day | 45 mg/day | 60 mg/day | 300 mg/day | |
| Duration | 2.5 years | 3 years | 1 year and 4 months | 3.5 years | |
| Total thyroidectomy (histology) | Yes (9 mm papillary microcarcinoma) | Yes (8 mm medullary carcinoma)* | Yes (Follicular hyperplasia) | Waiting | |
| OG Medical therapy | Treatment | - Local treatment (artificial tears) | - Local treatment (artificial tears) Iv MPDN (4.5 g) | - Local treatment (artificial tears) Iv MPDN (4.5 g) | - Local treatment (artificial tears, botulinum toxin injection) - Iv MPDN (8 g) Radiotherapy Tocilizumab |
| OG Surgical treatment (inactive phase) | Treatment | (2019) - Bilateral orbital decompression - Correction of eyelid retraction | (2020) - Bilateral orbital decompression - Correction of upper eyelids retraction | (2018) - Bilateral orbital decompression - Correction of upper eyelids retraction | (2020) - Bilateral orbital decompression |
| ivMPDN – intravenous methylprednisolone * negative for RET mutations, maintained cure criteria | |||||
Conclusion: In these four cases a definitive therapy (surgery) was needed to treat GD, suggesting the presence of a more severe disease. GO can progress into severe forms and this evolution is often unpredictable. These 4 clinical reports are illustrative of the importance of a multidisciplinary approach (Endocrinology and Ophthalmology) in specialized centers for patients with GD and GO.
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