Abstract:
Introduction: Graves’ orbitopathy (GO) constitutes a major clinical and therapeutic
challenge. GO is an autoimmune disorder representing the most common and most important
extrathyroidal manifestation of Graves’ disease. Although the pathogenesis of GO is beyond the
scope of this study, attention is drawn to the link between the orbit and thyroid, which has important
clinical and therapeutic implications. Optimal management of GO requires a coordinated approach
addressing the thyroid dysfunction and the orbitopathy.
Purpose and Objectives: To establish the relationship between Graves’ disease evolution and the
onset of ocular manifestations. To evaluate the activity and severity of GO in our study group.
Materials and Methods: This study is based on the clinical examination of 16 patients, using
the Clinical Activity Score (CAS) and the NOSPECS classification of the disease’s severity.
Results: During this study, we have seen 16 patients (32 eyes). 12 of these patients presented
bilateral involvement, while 4 — unilateral involvement. We have studied the onset of Graves’
orbitopathy in relation to the onset of hyperthyroidism, and we’ve determined that most commonly
GO occurs at the same time or follows the hyperthyroidism (up to 81% of cases). The activity of
GO was determined using CAS. We’ve determined that the spontaneous orbital pain, gaze evoked
orbital pain, conjunctival redness and the eyelid swelling were the most common manifestations
presented by our patients (50-75% of cases), while eyelid erythema was the less common (12.5%).
The frequency of active and inactive cases was almost equal, with a minor prevalence of active
processes. The disease’s severity was appreciated using NOSPECS classification. Most patients
presented a minimal grade of severity (43.7% - 7 patients), while 37.5% (6 patients) have presented
a moderate grade and only 18.8% (3 patients) - maximal severity. The first two classes of the NOSPECS (only signs and soft tissue involvement) were the most common, being found in 81
(13 cases) and 62.5% (10 cases) of patients respectively.
Conclusions: The amount of minimal and moderate severity of the Graves’ orbitopathy
imposing (81.2% ) in study group. These results indicate that in the majority of GO cases is
detected. The frequency of the CAS manifestations, as well as the predominance of the NOSPECS
classes, matches the results found in clinical randomised studies and literature.
