Welcome from Christian Nasr, MD
A large proportion of patients with Graves’ hyperthyroidism (GH) develop some degree of eye involvement; fortunately, however, only about 5% will experience severe manifestations of Graves ophthalmopathy (GO). It is unclear why the optical, mechanical, and appendicular components of the eye are susceptible to this process, but it is a fact that TSH receptors and cells of immunity in that body area play a major role in the pathogenesis of GO.
While the management of GH is relatively straightforward, that of GO can be very disappointing and fraught with morbidity that is sometimes worse than the disease itself.
Traditionally, the management of GO has depended on the affected ophthalmic component or the process involved, eg, orbital decompression when there is threat to vision, glucocorticoids for inflammation, muscle surgery for diplopia. The eyes are so delicate and physiologically important that their preservation is crucial—unlike the thyroid which can readily be sacrificed. Choosing the right therapeutic tool is therefore essential to preserve function and minimize disability.
The treating physician—whether primary care or specialist—will have to take all the above factors into account when deciding on a management strategy. The patient, on the other hand, faces the dilemma of balancing the morbidity of the intervention against the desired ophthalmic outcome. While dealing with this, the patient will endure variable effects on his/her quality of life, which is sometimes put on the back-burner by the provider.
In this review, the author selected 6 articles that he felt were representative of the topic at hand. They tackle the pathophysiology, evidence-based treatment modalities, and impact of the disease and the treatment on the patient’s quality of life.