Thyroid orbitopathy and diabetes

Czech version

Authors: J. Čáp
Authors‘ workplace: II. interní klinika Lékařské fakulty UK a FN, Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc.
Published in: Vnitř Lék 2007; 53(5): 524-527
Category:

Overview

Thyroid-associated ophthalmopathy (TAO) is an inflammatory process associated with autoimmune thyroid diseases (AITD), most commonly Graves disease. It is clinically present in up to one half of patients suffering with AITD and 3–5 % of patients suffer from intense pain and inflammation with double vision or even loss of vision. Because diabetes mellitus type 1 and AITD have similar pathogenesis and shared genetic background it is not surprising that up to 30 % of patients with type 1 diabetes develop AITD during long term follow-up. It is important to consider the activity and severity of TAO separately. Treatment is effective at the beginning of disease in the high activity phase. Glucocorticoids represent a milestone in the treatment of TAO and are necessary in diabetic patients as well. According to the latest experience the most effective and best tolerated regimen is iv glucocorticoid administration of methylprednisolone at weekly intervals up to a cumulative dose of 4.5 g. Orbital radiotherapy is considered to be contraindicated in patients with diabetes for fear of worsening retinopathy. Surgical orbital decompression is indicated in severe proptosis and progressive neuropathy in the acute stage. Rehabilitative (extraocular muscle or eyelid) surgery is often needed after treatment and inactivation of eye disease.

Key words:
thyroid associated ophtalmopaty – TAO – diabetes mellitus – treatment

Sources

1. Prabhakar BS, Bahn RS, Smith TJ Current perspective on the pathogenesis of Graves' disease and ophthalmopathy. Endocr Rev 2003; 24: 802-835.

2. Heufelder AE Pathogenesis of Graves' ophthalmopathy: recent controversies and progress. Eur J Endocrinol 1995; 132: 532-541.

3. Váňa S, Němec J, Rezek P et al. Význam stanovení protilátek proti receptoru pro TSH (TRAK) pro diagnostiku a sledování terapie endokrinní orbitopatie. Vnitř Lék 1994; 40: 636-638.

4. Gerding MN, van der Meer JW, Broenink M et al. Association of thyrotrophin receptor antibodies with the clinical features of Graves' ophthalmopathy. Clin Endocrinol (Oxf) 2000; 52: 267-271.

5. Feliciello A, Porcellini A, Ciullo I et al. Expression of thyrotropin-receptor mRNA in healthy and Graves' disease retro-orbital tissue. Lancet 1993; 342: 337-338.

6. Crisp MS, Lane C, Halliwell M et al. Thyrotropin receptor transcripts in human adipose tissue. J Clin Endocrinol Metab 1997; 82: 2003-2005.

7. Spitzweg C, Joba W, Hunt N et al. Analysis of human thyrotropin receptor gene expression and immunoreactivity in human orbital tissue. Eur J Endocrinol 1997; 136: 599-607.

8. Salvi M, Bernard N, Miller A et al. Prevalence of antibodies reactive with a 64 kDa eye muscle membrane antigen in thyroid-associated ophthalmopathy. Thyroid 1991; 1: 207-213.

9. Bahn RS, Gorman CA, Johnson CM et al. Presence of antibodies in the sera of patients with Graves' disease recognizing a 23 kilodalton fibroblast protein. J Clin Endocrinol Metab 1989; 69: 622-628.

10. Barker JM, Yu J, Yu L et al. Autoantibody “subspecificity” in type 1 diabetes: risk for organ-specific autoimmunity clusters in distinct groups. Diabetes Care 2005; 28: 850-855.

11. Prazny M, Skrha J, Limanova Z et al. Screening for associated autoimmunity in type 1 diabetes mellitus with respect to diabetes control. Physiol Res 2005; 54: 41-48.

12. Barker JM Clinical review: Type 1 diabetes-associated autoimmunity: natural history, genetic associations, and screening. J Clin Endocrinol Metab 2006; 91: 1210-1217.

13. Umpierrez GE, Latif KA, Murphy MB et al. Thyroid dysfunction in patients with type 1 diabetes: a longitudinal study. Diabetes Care 2003; 26: 1181-1185.

14. Golden B, Levin L, Ban Y et al. Genetic analysis of families with autoimmune diabetes and thyroiditis: evidence for common and unique genes. J Clin Endocrinol Metab 2005; 90: 4904-4911.

15. Vondra K, Vrbíková J, Dvořáková K Thyroid gland diseases in adult patients with diabetes mellitus. Minerva Endocrinol 2005; 30: 217-236.

16. Pfeilschifter J, Ziegler R Smoking and endocrine ophthalmopathy: impact of smoking severity and current vs lifetime cigarette consumption. Clin Endocrinol (Oxf) 1996; 45: 477-481.

17. Shine B, Fells P, Edwards OM et al. Association between Graves’ ophthalmopathy and smoking. Lancet 1990; 335: 1261-1263.

18. Bartalena L, Marcocci C, Bogazzi F et al. Relation between therapy for hyperthyroidism and the course of Graves' ophthalmopathy. N Engl J Med 1998; 338: 73-78.

19. Classification of eye changes of Graves’ disease. Thyroid 1992; 2: 235-236.

20. Werner SC Modification of the classification of the eye changes of Graves’ disease: recommendations of the Ad Hoc Committee of the American Thyroid Association. J Clin Endocrinol Metab 1977; 44: 203-204.

21. Bartalena L, Pinchera A, Marcocci C Management of Graves’ ophthalmopathy: reality and perspectives. Endocr Rev 2000; 21: 168-199.

22. Marcocci C, Bartalena L, Tanda ML et al. Comparison of the effectiveness and tolerability of intravenous or oral glucocorticoids associated with orbital radiotherapy in the management of severe Graves’ ophthalmopathy: results of a prospective, single-blind, randomized study. J Clin Endocrinol Metab 2001; 86: 3562-3567.

23. Marino M, Morabito E, Brunetto MR et al. Acute and severe liver damage associated with intravenous glucocorticoid pulse therapy in patients with Graves’ ophthalmopathy. Thyroid 2004; 14: 403-406.

24. Bartalena L Editorial: glucocorticoids for Graves’ ophthalmopathy: how and when. J Clin Endocrinol Metab 2005; 90: 5497-5499.

25. Kahaly GJ, Pitz S, Hommel G et al. Randomized, single blind trial of intravenous versus oral steroid monotherapy in Graves’ orbitopathy. J Clin Endocrinol Metab 2005; 90: 5234-5240.

26. Prummel MF, Terwee CB, Gerding MN et al. A randomized controlled trial of orbital radiotherapy versus sham irradiation in patients with mild Graves’ ophthalmopathy. J Clin Endocrinol Metab 2004; 89: 15-20.

27. Bartalena L, Marcocci C, Pinchera A Orbital radiotherapy for Graves’ ophthalmopathy. J Clin Endocrinol Metab 2004; 89: 13-14.

28. Prummel MF, Mourits MP, Berghout A et al. Prednisone and cyclosporine in the treatment of severe Graves’ ophthalmopathy. N Engl J Med 1989; 321: 1353-1359.

29. Kahaly G, Schrezenmeir J, Krause U et al. Ciclosporin and prednisone v. prednisone in treatment of Graves’ ophthalmopathy: a controlled, randomized and prospective study. Eur J Clin Invest 1986; 16: 415-422.

30. Dickinson AJ, Vaidya B, Miller M et al. Double-blind, placebo-controlled trial of octreotide long-acting repeatable (LAR) in thyroid-associated ophthalmopathy. J Clin Endocrinol Metab 2004; 89: 5910-5915.

31. Wemeau JL, Caron P, Beckers A et al. Octreotide (long-acting release formulation) treatment in patients with Graves’ orbitopathy: clinical results of a four-month, randomized, placebo-controlled, double-blind study. J Clin Endocrinol Metab 2005; 90: 841-848.