Diagnostic evaluation of Graves' ophthalmopathy

The important questions to be answered in the course of decision-making in patients with Graves' ophthalmopathy include the following: 1. Is the eye problem owing to Graves' ophthalmopathy? If not, the cause of the eye problem must be sought. 2. Does the patient have serious medical problems apart from the thyroid and the eyes? Define type and severity, and risk to life and well-being. Do they preclude anesthesia or steroid therapy? 3. Is the patient euthyroid? Define thyroid abnormality and treat. 4. Is the eye problem the highest medical priority for the patient and the physician? If not, treat the highest priority, then return to the eyes. 5. Which particular manifestations of Graves' ophthalmopathy are the most troublesome to the patient? Establish priorities according to need and rational order for surgical procedures. 6. How have the eyes been treated in the past? What has been successful? What side effects have resulted? In the evaluation of a patient with possible Graves' ophthalmopathy, no single clinical or laboratory feature is necessary or pathognomonic of the disorder. The sufficient findings for a diagnosis are a matter of clinical judgment. Several diagnostic tools including CT scanning, various ophthalmologic examinations, and studies of thyroid function are available. The physician must use these tools, along with clinical judgment, to establish the diagnosis with maximum certainty. Following this, the particular manifestations of the disease that are most troublesome to the patient must be carefully defined and assessed. Only then can the treatment be optimally tailored to the patient's needs.