Progress in Thyroid Associated Ophthalmopathy

Eckstein A.,
Universität-Gesamthochschule Essen, Zentrum für Augenheilkunde (Essen)

Thyroid Associated Ophthalmopathy (TAO) is an inflammatory orbital disease, which is associated to Graves' hyperthyroidism. The course of TAO is influenced by thyroid disease. A severe course of the disease is associated with high hormon levels at the beginning of the disease, high thyroid volume and high levels of TSH-receptor-antibody (TSHR-AB). Expression of TSHR is augmented in orbital tissue from patients with TAO. TSH-receptor is the prime candidate to be the shared by orbital and thyroidal antigen. In animal models of TAO, using the TSHR cDNA immunization or the transfer of TSHR primed T-cells, a part of the mice develop thyroiditis and orbital changes similar to TAO. TSHR-AB are unfortunatly not always associated to the course of the disease, so there must be other important influencing factors, such as smoking and stressful live events. A great advantage for the initiation of therapy is the appreciation of disease activity and severity. Oral and (in severe cases) intravenous steroids and/or orbital irradiation are still the widely accepted therapeutic options, which have been proven in controlled studies. The efficasy of new antiinflammatory and immunosuppressive drugs as well as the adjuvant therapies like antioxidants, have to be proven in prospective controlled trials. In the inactive state new and classical surgical techniques are available for rehabilitation. The sequence of surgery should start with orbital surgery, followed by extraocular muscle surgery and finally by eyelid surgery. The ideal aim to prevent the development of TAO in patients with acute diagnosed autoimmune hyperthyreoidism is still far away.

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