[Thyroid orbital pathologies in ophthalmological settings].
OBJECTIVE
To illustrate the originality and diversity of an ophthalmologic pathology associated with a thyroid disease (OATD), we report 42 cases of patients hospitalised or having consulted an ophthalmologic department for this disease over a period of 4 years.


METHODS
Each patient was assessed by an endocrinologist and an ophthalmologist. Data included the OATD severity score, date of occurrence compared with the thyroid disease and determination of thyroid function and immune abnormalities.


RESULTS
Patients were aged a mean of 48.9 + 15.3 years; 65% were women and 39% smokers. OATD preceded the thyroid disease in 38% of cases, was concomitant in 40% and successive in 21%. Thirty-six percent of cases were mild, 45% moderate and 19% were severe. One patient out of 5 had exhibited a period of iatrogenic hypothyroidia. The majority (81%) presented with Basedow's disease; 14% Hashimoto's disease; 73% anti-TSH receptor antibodies and 56% anti-thyroperoxidase antibodies. Two profiles of patients with OAMT were identified. A first group with severe OATD: Basedow's disease, presence of anti-TSH receptor antibodies and a period of iatrogenic hypothyroidia in half of the cases. A second group in which the occurrence of OATD preceded diagnosis of a thyroid disease: generally non-severe forms with varying thyroid status, strongly related to the moment at which the patient consulted, compared with the progression of the ophthalmologic and thyroid affections.


CONCLUSIONS
When faced with signs evoking OATD, these data emphasize the need for an evaluation of thyroid status and determination of the antibodies implied in Basedow and Hashimoto's disease. After initiation of synthetic anti-thyroid or radioactive iodine therapy, the evolution of the thyroid and ophthalmologic status of hyperthyroid patients must be carefully monitored.
Lissak
B
B
Service de médecine interne, CHNO des Quinze-Vingts, 28, rue de Charenton, F-75571 Paris. b.lissak@quinze-vingts.fr
Tazartes
M
M
Heron
E
E
Feldman
S
S
D000328:Adult; D000367:Age Factors; D001323:Autoantibodies / Q000032:analysis; D005260:Female; D006111:Graves Disease / Q000175:diagnosis / Q000276:immunology; D006801:Humans; D007453:Iodide Peroxidase / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011989:Receptors, Thyrotropin / Q000276:immunology; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D013965:Thyroidectomy; D013967:Thyroiditis, Autoimmune / Q000175:diagnosis / Q000276:immunology; D014792:Visual Acuity
D001323:Autoantibodies; D011989:Receptors, Thyrotropin; D007453:Iodide Peroxidase