Advertisement

A Complicated Case of Thyroid Eye Disease

  • Bernard Y. P. Chang
  • Ramzi Ajjan

Abstract

Clinical thyroid eye disease (TED) is found in up to 50 % of patients with Graves’ disease. Fortunately, the majority of cases are mild requiring topical treatment or no intervention at all. However, some cases can be severe and in extreme cases may threaten vision.

The current chapter addresses the management of a patient with type 1 diabetes who develops Graves’ disease complicated by severe TED. This case illustrates the difficulties encountered in the management of patients with complicated TED.

Keywords

Thyroid eye disease Clinical activity score Proptosis Optic nerve compression Pulsed iv methylprednisolone Orbital decompression 

References

  1. 1.
    Perros P, Neoh C, Dickinson J. Thyroid eye disease. BMJ. 2009;338:b560.CrossRefPubMedGoogle Scholar
  2. 2.
    Bartalena L, Marcocci C, Tanda ML, Piantanida E, Lai A, Marinò M, et al. An update on medical management of Graves’ ophthalmopathy. J Endocrinol Invest. 2005;28:469–78.CrossRefPubMedGoogle Scholar
  3. 3.
    Stiebel-Kalish H, Robenshtok E, Hasanreisoglu M, Ezrachi D, Shimon I, Leibovici L. Treatment modalities for Graves’ ophthalmopathy: systematic review and metaanalysis. J Clin Endocrinol Metab. 2009;94:2708–16.CrossRefPubMedGoogle Scholar
  4. 4.
    Verity DH, Rose GE. Acute thyroid eye disease (TED): principles of medical and surgical management. Eye (Lond). 2013;27:308–19.CrossRefGoogle Scholar
  5. 5.
    Bartalena L. The dilemma of how to manage Graves’ hyperthyroidism in patients with associated orbitopathy. J Clin Endocrinol Metab. 2011;96:592–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Shen S, Chan A, Sfikakis PP, Hsiu Ling AL, Detorakis ET, Boboridis KG, et al. B-cell targeted therapy with rituximab for thyroid eye disease: closer to the clinic. Surv Ophthalmol. 2013;58:252–65.CrossRefPubMedGoogle Scholar
  7. 7.
    Bhatt R, Nelson CC, Douglas RS. Thyroid-associated orbitopathy: current insights into the pathophysiology, immunology and management. Saudi J Ophthalmol. 2011;25:15–20.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Bartalena L, Fatourechi V. Extrathyroidal manifestations of Graves’ disease: a 2014 update. J Endocrinol Invest. 2014;37:691–700.CrossRefPubMedGoogle Scholar
  9. 9.
    Altiparmak UE, Acar DE, Ozer PA, Emec SD, Kasim R, Ustun H, et al. Topical cyclosporine A for the dry eye findings of thyroid orbitopathy patients. Eye (Lond). 2010;24:1044–50.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Department of OphthalmologyLeeds Teaching Hospitals NHS TrustLeedsUK
  2. 2.Cardiovascular and Diabetes ResearchUniversity of LeedsLeedsUK

Personalised recommendations