[Thyroid orbitopathy and diabetes].
Thyroid-associated ophthalmopathy (TAO) is an inflammatory process associated with autoimmune thyroid diseases (AITD), most commonly Graves disease. It is clinically present in up to one half of patients suffering with AITD and 3-5 % of patients suffer from intense pain and inflammation with double vision or even loss of vision. Because diabetes mellitus type 1 and AITD have similar pathogenesis and shared genetic background it is not surprising that up to 30% of patients with type 1 diabetes develop AITD during long term follow-up. It is important to consider the activity and severity ofTAO separately. Treatment is effective at the beginning of disease in the high activity phase. Glucocorticoids represent a milestone in the treatment of TAO and are necessary in diabetic patients as well. According to the latest experience the most effective and best tolerated regimen is iv glucocorticoid administration of methylprednisolone at weekly intervals up to a cumulative dose of 4.5 g. Orbital radiotherapy is considered to be contraindicated in patients with diabetes for fear of worsening retinopathy. Surgical orbital decompression is indicated in severe proptosis and progressive neuropathy in the acute stage. Rehabilitative (extraocular muscle or eyelid) surgery is often needed after treatment and inactivation of eye disease.
Cáp
J
J
II interní klinika Lékarské fakulty UK a FN, Hradec Králové. capj@lfhk.cuni.cz
D048909:Diabetes Complications / Q000175:diagnosis / Q000628:therapy; D049970:Graves Ophthalmopathy / Q000175:diagnosis / Q000628:therapy; D006801:Humans