Clinical characteristics of Graves’ orbitopathy

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.