Thyroid orbitopathy

Thyroid orbitopathy (thyroid eye disease, thyroid ophthalmopathy) is an organ specific, autoimmune disorder with the potential to cause severe functional and psychosocial effects.

This article reviews the clinical features with particular emphasis on current management.

Thyroid orbitopathy is most prevalent in women aged 40-50 years and is usually associated with thyroid dysfunction. Clinical manifestations include soft tissue signs, lid retraction, lid lag, proptosis, restrictive myopathy, corneal exposure and optic neuropathy. Thyroid function tests are essential, while thyroid antibodies and imaging to demonstrate extraocular muscle enlargement may also aid diagnosis. Correction of thyroid dysfunction and supportive measures are necessary in all cases. Immunosuppression is reserved for moderate to severe active orbitopathy and rehabilitative surgery is generally used once the disease is quiescent. A good visual and cosmetic outcome requires close cooperation between the general practitioner, endocrinologist and ophthalmologist.