Protocolo de diagnóstico y tratamiento de la oftalmopatía tiroidea

Abstract

IntroductionGraves’ ophtalmopathy/orbitopathy (GO) is the most common and invalidating extrathyroidal expression of Graves’ disease (GD).Epidemiology GO prevalence in the general population is between 0.1 and 0.3%. EtiologyIncreased volume in both the extraocular muscles and retroorbital connective and adipose tissue due to cellular proliferation, inflammation and accumulation of glicosaminoglycans. DiagnosisHyperthyroidism and positive TSH receptor antibodies make the diagnosis straightforward. When needed, complementary imaging techniques (orbital ultrasonography, computerized tomography scan or magnetic resonance imaging) confirm the diagnosis. TreatmentAll subjects with ophtalmopathy should benefit from restoration to the euthyroid state, smoking withdrawal and local therapy. In the active phase of the disease, medical treatment relies on the use of selenium, high dose of systemic glucocorticoids or retro-orbital irradiation, either alone or in combination. Later on, surgery (orbital decompression, squint surgery, and eyelid surgery) could be needed in the inactive phase of the disease. Management requires a multidisciplinary approach.