Endocrine Orbitopathy - Medical Experts

Endocrine orbitopathy is a common symptom of Graves’ disease. In Graves’ disease, autoantibodies are produced that bind to specific receptor molecules for thyroid hormones. 

This occurs primarily in the thyroid gland, on connective tissue cells, or in the area behind the eyes. When these autoimmune antibodies bind to these cells and tissues, they trigger inflammatory reactions. This leads to connective tissue changes.

At the same time, immune cells migrate to the site of inflammation. Fluid leaks into the tissue, leading to the formation of edema. There is also an increase in the formation of connective tissue fibers. If these processes occur behind the eye, the volume increases. The eye bulges forward, resulting in the characteristic exophthalmos, also known as endocrine orbitopathy.

It is interesting to note that women are three times more likely to develop endocrine orbitopathy than men.

As the disease progresses, the tissue surrounding the eyeball continues to increase in mass. It typically exerts pressure on the eyeballs on both sides. One in two patients with Graves’ disease develops endocrine orbitopathy.

The eyeballs may protrude significantly beyond the eye sockets, making them appear very large. Eyelid closure is also restricted as exophthalmos worsens. 

In connection with the protruding eyes, a number of other symptoms may occur, such as:

• dry eyes
• increased tearing
• pressure or pain in the eye
• swelling of the eyelids
• impaired vision,
• sensitivity to light, among other symptoms

Characteristic symptoms include protruding eyeballs, swelling, and redness around the eyelids and conjunctiva @ Andriy Blokhin /AdobeStock

In cases of known Graves’ disease or hyperthyroidism, an examination by an ophthalmologist is sufficient. The ophthalmologist can diagnose endocrine orbitopathy.

If there is no pre-existing condition, doctors will also examine the thyroid gland. The thyroid gland can be easily palpated on the front of the neck. If in doubt, physicians use an ultrasound device to confirm the findings.

To rule out an endocrine disorder such as Graves’ disease, the endocrine orbitopathy specialist orders a blood test. This allows them to check thyroid levels. 

Among the most important markers is TSH, the thyroid-stimulating hormone. In addition, there are thyroid antibodies such as TRAK or TPO-AK, which circulate in the blood in cases of Graves’ disease.

If endocrine orbitopathy is suspected, the doctor performs a thyroid examination @ Andriy Blokhin /AdobeStock

The most important thing is for patients to achieve a balanced metabolic state. This is achieved through medication.

If the eye disease continues to progress despite a normal metabolic state, glucocorticoids or radiation therapy behind the eyeball may help.

The IGF receptor inhibitor teprotumumab is another medical treatment option.

If vision is acutely threatened, surgery to relieve pressure is necessary if glucocorticoid therapy is unsuccessful. 

Surgical procedures include:

• Lateral orbital decompression or
• Endonasal orbital decompression 

Early initiation of treatment further improves the already good prognosis, even though exophthalmos itself is incurable. 

Smoking, on the other hand, significantly worsens the course of the disease and the prognosis. Therefore, patients should quit smoking completely.

Exophthalmos involves various medical specialties:

• Ophthalmology
• Endocrinology 
• Other areas of internal medicine

Surgical treatment of endocrine orbitopathy requires expertise in the field of ophthalmic surgery.

You can find specialists in endocrine orbitopathy and medical centers with extensive experience in this field listed above.