[Graves' orbitopathy].
Graves' orbitopathy or thyroid associated orbitopathy is the most frequent extrathyroidal manifestation of Graves' disease with autoimmune mechanism which is still incompletely understood. The epidemiologic data provided evidence that severe, infiltrative orbitopathy is present in 3-5% of patients, and the quality of life is impaired even in individuals with mild form of this disease. The anti-TSH receptor and anti-eye muscle autoantibodies have been proved to be involved into pathomechanism of orbitopathy. The accumulation of glucose-aminoglycan and proinflammatory cytokines in retro-orbital fibroblasts are responsible for enlargement of eye muscle and the retro-orbital tissues resulting in inflammation of periorbital tissues and proptosis. Management of orbitopathy can be either medical and surgical. The medical therapy relies on the use of high dose systemic glucocorticoids or retro-orbital irradiation, either alone or in combination. Recent randomized clinical trials have confirmed that glucocorticoids are more effective in intravenous than oral use. Retro-orbital radiotherapy is an effective and safe therapy for orbitopathy and the side effects are avoidable. Somatostatin analogs are not so effective as it has been waited in previous studies. The high dose intravenous immunoglobulins and pentoxifylline therapy are favorable, however, prospective randomized trials have been not yet made. The manifestation of orbitopathy includes both unavoidable (genetic background) and avoidable (smoking, cytokine therapy, iodine exposure, radioiodine therapy) risk factors. Cigarette smoking must be given up by all patients with Graves' disease. Pentoxifylline therapy is advisable for all patients with Graves'diseases, especially for those who have genetic susceptibility to autoimmune disorders and not able to give up cigarette smoking.
Balázs
Csaba
C
Budai Irgalmasrendi Kórház, Belgyógyászat Budapest. drbalazs@irgalmaws.hu
D006111:Graves Disease / Q000150:complications / Q000209:etiology; D049970:Graves Ophthalmopathy / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications