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Endokrine Orbitopathie

Graves’ ophthalmopathy

Der Internist volume 51, pages 584–595 (2010)Cite this article

Zusammenfassung

Die endokrine Orbitopathie ist Teil einer systemischen Autoimmunerkrankung, die eine Hyperthyreose, eine Orbitopathie, eine Akropachie und das prätibiale Myxödem umfasst (Morbus Basedow). Dabei spielen Anti-TSH-Rezeptor-Antikörper eine zentrale pathogenetische Rolle. Kardinalsymptome der endokrinen Orbitopathie sind periorbitale Entzündung, Exophthalmus, verringerte Augenbeweglichkeit und erweiterte Lidspalten. Bei der Entstehung der Orbitopathie spielen die entzündlichen Reaktionen der Orbitafibroblasten die zentrale Rolle. Bei moderaten und schweren Verläufen ist eine antientzündliche Therapie (meist i.v.-Steroidstoß und Orbitabestrahlung) und im Notfall eine Orbitadekompression indiziert. Bei milden Verläufen kann abgewartet oder Selen verabreicht werden. Operative Maßnahmen haben im inaktiven Stadium die Wiederherstellung eines normalen Aussehens und der Funktion zum Ziel. Die Normalisierung der Schilddrüsenfunktion führt bei mehr als der Hälfte der Patienten zu einer Verbesserung der endokrinen Orbitopathie. Ohne begleitende Steroidtherapie ist eine Radiojodtherapie mit einem 15%igen Risiko der Verschlechterung oder des Neuauftretens einer endokrinen Orbitopathie verbunden. Eine Thyreoidektomie ist im Spätstadium ohne Effekt und in der Frühphase möglicherweise von Vorteil.

Abstract

Graves’ orbitopathy is part of an autoimmune systemic disease which compiles hyperthyroidism, orbitopathy, dermopathy and acropachy. Stimulating antibodies against the TSH receptor play the central pathogenetic role. Main symptoms of Graves’ orbitopathy comprise soft tissue inflammation, proptosis impairment of ocular motility and lid retraction. Inflammatory reactions of orbital fibroblasts are responsible for the symptoms. To restrict damage anti-inflammatory therapy (mainly systemic steroids, orbital irradiation) is indicated in moderate to severe active disease stages, and surgical orbital decompression in sight threatening states. In mild cases expectant strategy and selenium administration is sufficient. In inactive disease stages surgery is performed to improve appearance and function. Restoring euthyroidism leads to improvement of Graves’ orbitopathy in about 60% of the patients. Radioiodine therapy without glucocorticoids is associated with a small but significant risk (15%) of deterioration or relapse. Thyroidectomy is neutral in later stages but may improve Graves’ orbitopathy in early active stages.

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Affiliations

  1. Zentrum für Augenheilkunde, Universitätsklinikum, Hufelandstraße 55 , 45122, Essen, Deutschland

    A. Eckstein & J. Esser

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  1. A. Eckstein
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  2. J. Esser
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Correspondence to A. Eckstein.

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Eckstein, A., Esser, J. Endokrine Orbitopathie. Internist 51, 584–595 (2010). https://doi.org/10.1007/s00108-009-2497-5

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  • DOI: https://doi.org/10.1007/s00108-009-2497-5

Schlüsselwörter

  • Endokrine Orbitopathie
  • Morbus Basedow
  • Exophthalmus
  • Hyperthyreose

Keywords

  • Endocrine orbitopathy
  • Graves’ disease
  • Morbus Basedow
  • Exophthalmus
  • Hyperthyreosis