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Graves Orbitopathy

  • Stefano Natali and Paul Shogan
Published/Copyright: June 1, 2020
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 120 Issue 6

A 67-year-old woman presented to her gastroenterologist with 30 lb of unexplained weight loss, anxiety, and bilateral eyelid swelling with tenderness over a 5-month period. Her medical history included hypertension, stroke, and tobacco use. Esophagogastroduodenoscopy, colonoscopy, and abdominopelvic computed tomography (CT) results were unremarkable. CT of the orbit and sella turcica with and without contrast demonstrated bilateral exophthalmos with symmetric enlargement of the inferior and medial rectus muscles of both orbits (image A and image B), compatible with thyroid-associated orbitopathy.

It is estimated that Graves orbitopathy (GO) is prevalent in only 20% to 25% of patients with Graves disease.1 Imaging demonstrates bilateral symmetric enlargement of the extraocular muscles (EOMs), most commonly affecting the inferior and medial rectus.2 A 2017 study3 was successful in quantifying the severity of active disease by using CT parameters to demonstrate increases in volumetric measurements of EOM and orbital fat in those with active inflammation vs healthy controls. For the most accurate measurements, the axial plane is preferred.4 The clinical activity score assesses GO severity by assigning a point for each pertinent clinical sign of inflammation. This score can be directly correlated to the EOM-to-total orbital ratio; when a patient's clinical signs improve, the ratio diminishes.5

From the Edward Via College of Osteopathic Medicine–Carolinas Campus and the Regional Medical Center in Orangeburg, South Carolina.
Financial Disclosures: None reported.
Support: None reported.

*Address correspondence to Stefano Natali, OMS IV, 5770 SW 53rd Terrace, Miami, FL, 33155-6334. Email:

References

1. TandaML, PiantanidaE, LiparuloL, et al.. Prevalence and natural history of Graves' orbitopathy in a large series of patients with newly diagnosed graves' gyperthyroidism seen at a single center. J Clin EndocrinolMetab. 2013;98(4):1443-1449. doi:10.1210/jc.2012-3873Search in Google Scholar PubMed

2. GonçalvesAC, GebrimEM, MonteiroML. Imaging studies for diagnosing Graves' orbitopathy and dysthyroid optic neuropathy. Clinics (Sao Paulo). 2012;67(11):1327-1334. doi:10.6061/clinics/2012(11)18Search in Google Scholar PubMed PubMed Central

3. ByunJS, MoonNJ, Lee, JK. Quantitative analysis of orbital soft tissues on computed tomography to assess the activity of thyroid-associated orbitopathy. Graefe's Arch Clin Exp Ophthalmol. 2017;255(2):413-420. doi:10.1007/s00417-016-3538-0Search in Google Scholar PubMed

4. BijlsmaWR, MouritsMPl. Radiologic measurement of extraocular muscle volumes in patients with Graves' orbitopathy: a review and guideline.Orbit. 2006;25(2):83-91. doi:10.1080/01676830600675319Search in Google Scholar PubMed

5. Le MoliR, PluchinoA, MusciaV, et al.. Graves’ orbitopathy: extraocular muscle/total orbit area ratio is positively related to the clinical activity score. Eur J Ophthalmol. 2012;22(3):301-308. doi:10.5301/ejo.5000018Search in Google Scholar PubMed

Received: 2019-08-14
Accepted: 2019-08-22
Published Online: 2020-06-01
Published in Print: 2020-06-01

© 2020 American Osteopathic Association

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https://doi.org/10.7556/jaoa.2020.068

Articles in the same Issue

  1. SURF
  2. Lumbar Diagnosis and Pressure Difference Variance
  3. OMT MINUTE
  4. Osteopathic Manipulative Treatment for Low Back Pain
  5. LETTERS TO THE EDITOR
  6. Influence of Research on Osteopathic Medical Student Residency Match Success
  7. ORIGINAL CONTRIBUTION
  8. How Trainees Finance Their Medical Education: Implications of Higher Education Act Reform
  9. Choosing Primary Care: Factors Influencing Graduating Osteopathic Medical Students
  10. BRIEF REPORT
  11. Empathy in Medicine Self and Other in Medical Education: Initial Emotional Intelligence Trend Analysis Widens the Lens Around Empathy and Burnout
  12. ORIGINAL CONTRIBUTION
  13. Implied Evidence of the Functional Role of the Rectus Capitis Posterior Muscles
  14. REVIEW
  15. The Role of Sphenobasilar Synchondrosis in Disease and Health
  16. CLINICAL PRACTICE
  17. Partnering With Patients to Reduce Firearm-Related Death and Injury
  18. SPECIAL COMMUNICATION
  19. Buying Time: Using OMM to Potentially Reduce the Demand for Mechanical Ventilation in Patients With COVID-19
  20. CASE REPORT
  21. Integrating Osteopathic Manipulative Treatment and Injections in the Diagnosis and Management of a Hip Labral Tear
  22. CLINICAL IMAGES
  23. Graves Orbitopathy
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