A sight into the pathogenesis and treatment of thyroid-associated ophthalmopathy

Aleksandra Krzemienowska-Cebulla
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Małgorzata Puziewicz-Krzemienowska
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Mateusz Dorochowicz
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Iwona Matus
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Faculty of Medicine, Wrocław Medical University, Wrocław, Poland
Faculty of Medicine, Wrocław Medical University, Wrocław, Poland
Faculty of Medicine, Wrocław Medical University, Wrocław, Poland
Faculty of Medicine, Wrocław Medical University, Wrocław, Poland
Received: 11.01.2024 / Revised: 20.02.2024 / Accepted: 21.02.2024 / Published: 30.06.2024

Abstract

Introduction and aim. Thyroid-associated ophthalmopathy (TAO), often referred to as thyroid eye disease or Graves’ ophthalmopathy, is a syndrome characterized by autoimmune inflammation affecting the eye muscles, connective tissue, and orbital fat. The aim of this literature review is to present TAO and integrate the available data in the literature regarding the pathogenesis and treatment methods. Based on these, the authors aim to examine whether, despite the extensive knowledge already available on TAO, there are still issues to be investigated.

Material and methods. In this literature review, books and scientific publications in both Polish and English languages have been assessed. The search criteria included keywords such as TAO, Graves’ disease, thyroid-associated ophthalmopathy. The evaluation covered the following databases: PubMed, Scopus, Google Scholar.

Analysis of the literature. Typically, the eyeball is not involved, but in exceptional cases, corneal ulceration may occur, or inflammation of the optic nerve may ensue. TAO most commonly occurs in the course of hyperthyroidism in Graves’ disease, involving up to 25–50% of cases. The coexistence of autoantigens shared between the thyroid and orbital tissues is considered the primary cause of TAO when it occurs concurrently with hyperthyroidism, later in its course, or even preceding the manifestation of hyperthyroidism, with or without concurrent thyroid dysfunction. TAO is generally bilateral, although dominance on one side is often observed. Common symptoms include eye pain, photophobia, diplopia, varying degrees of proptosis, and impaired vision. The cornerstone of treatment lies in managing hyperthyroidism, as TAO cannot be cured without it.

Conclusion. First-line treatment involves glucocorticoids, with radiation therapy as a supplementary option, and in cases unresponsive to pharmacological treatment, surgical intervention may be necessary.

 

Cite

Krzemienowska-Cebulla A, Puziewicz-Krzemienowska M, Dorochowicz M, Matus I. A sight into the pathogenesis and treatment of thyroid-associated ophthalmopathy. Eur J Clin Exp Med. 2024;22(2):432–438. doi: 10.15584/ejcem.2024.2.28.

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