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Ögonförändringar vid hypertyreos (endokrin oftalmopati)

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Definition:
Ögonförändringar vid hypertyreos
Förekomst:
Prevalens av ögonsymtom vid Graves sjukdom är 25-50 %
Symtom:
Tillståndet är obehagligt, smärtsamt, kosmetiskt störande och kan i ovanliga fall hota synen
Kliniska fynd:
Exoftalmus, ofta asymmetrisk, ibland ensidig. Ögonlocksretraktion, där hornhinnans övre kant är synlig och övre ögonlocket inte följer med när patienten tittar ned. Svullnad och rodnad i konjunktiva.
Diagnostik:
Typisk anamnes och kliniska fynd. FT4, FT3, TSH, TRAk och anti-TPO. Ögonundersökning. CT eller MR differentierar mellan endokrin oftalmopati och tumör i ögonhålan
Behandling:
Behandla hypertyreosen . De flesta patienter har lindriga ögonförändringar som endast kräver symtomatisk behandling. Höga steroiddoser, strålbehandling eller kirurgi kan vara aktuellt i vissa fall
  1. Cawood T, Moriarty P, O'Shea D. Recent developments in thyroid eye disease. BMJ 2004; 329: 385-90. PubMed  
  2. Bahn RS, Heufelder AE. Pathogenesis of Graves' ophthalmopathy. N Engl J Med 1993; 329: 1468-75. New England Journal of Medicine  
  3. Bartalena L, Pinchera A, Marcocci C. Management of Graves' ophthalmopathy: reality and perspectives. Endocr Rev 2000; 21: 168-99. PubMed  
  4. Boulakh L, Nygaard B, Bek T et al. Nationwide Incidence of Thyroid Eye Disease and Cumulative Incidence of Strabismus and Surgical Interventions in Denmark. JAMA Ophthalmol. 2022 Jul 1;140(7):667-673. PMID: 35588051 PubMed  
  5. Vestergaard P. Smoking and thyroid disorders - a meta-analysis. Eur J Endocrinol 2002; 146: 153-61. PubMed  
  6. Pfeilschifter J, Ziegler R. Smoking and endocrine ophthalmopathy: impact of smoking severity and current vs lifetime cigarette consumption. Clin Endocrinol (Oxf) 1996; 45(4): 477-81. PubMed  
  7. Bartalena L, Marcocci C, Tanda ML, Manetti L, Dell'Unto E, Bartolomei MP, et al. Cigarette smoking and treatment outcomes in Graves ophthalmopathy. Ann Intern Med 1998; 129: 632-5. Annals of Internal Medicine  
  8. Bartalena L, Marcocci C, Bogazzi F, Manetti L, Tanda ML, Dell'Unto E, et al. Relation between therapy for hyperthyroidism and the course of Graves' ophthalmopathy. N Engl J Med 1998; 338: 73-8. New England Journal of Medicine  
  9. Manso PG, Furlanetto RP, Wolosker AM, Paiva ER, de Abreu MT, Maciel RM. Prospective and controlled study of ophthalmopathy after radioiodine therapy for Graves' hyperthyroidism. Thyroid 1998; 8(1): 49-52. PubMed  
  10. Bahn RS, Bartley GB, Gorman CA. Emergency treatment of Graves' ophthalmopathy. Baillieres Clin Endocrinol Metab 1992; 6(1): 95-105. PubMed  
  11. Eckstein A, Quadbeck B, Mueller G, Rettenmeier AW, Hoermann R, Mann K, et al. Impact of smoking on the response to treatment of thyroid associated ophthalmopathy. Br J Ophthalmol 2003; 87: 773-6. British Journal of Ophthalmology  
  12. Hart RH, Perros P. Glucocorticoids in the medical management of Graves' ophtalmopathy. Minerva Endocrinol 2003; 28: 223-31. PubMed  
  13. Aktaran S, Akarsu E, Erbagci I, Araz M, Okumus S, Kartal M. Comparison of intravenous methylprednisolone therapy vs. oral methylprednisolone therapy in patients with Graves` ophthalmopathy. Int J Clin Pract 2007; 61: 45-51. PubMed  
  14. Bartalena L, Marcocci C, Chiovato L, Laddaga M, Lepri G, Andreani D, et al. Orbital cobalt irradiation combined with systemic corticosteroids for Graves’ ophthalmopathy: comparison with systemic corticosteroids alone. J Clin Endocrinol Metab 1983; 56(6): 1139-44. PubMed  
  15. Wiersinga WM, Smit T, Schuster-Uittenhoeve AL, van der Gaag R, Koornneef L. Therapeutic outcome of prednisone medication and of orbital irradiation in patients with Graves’ ophthalmopathy. Ophthalmologica 1988; 197(2): 75-84. PubMed  
  16. Mourits MP, van Kempen-Harteveld ML, Garcia MB, Koppeschaar HP, Tick L, Terwee CB. Radiotherapy for Graves' orbitopathy: randomised placebo-controlled study. Lancet 2000; 355: 1505-9. PubMed  
  17. Gorman CA, Garrity JA, Fatourechi V, Bahn RS, Petersen IA, Stafford SL, et al. A prospective, randomized, double-blind, placebo-controlled study of orbital radiotherapy for Graves' ophthalmopathy. Ophthalmology 2001; 108: 1523-34. PubMed  
  18. Prummel MF, Terwee CB, Gerding MN, Baldeschi L, Mourits MP, Blank L, et al. A randomized controlled trial of orbital radiotherapy versus sham irradiation in patients with mild Graves' ophthalmopathy. J Clin Endocrinol Metab 2004; 89(1): 15-20. PubMed  
  19. Perros P, Neoh C, Dickinson J. Thyroid eye disease. Clinical review. BMJ 2009; 338: b560. BMJ (DOI)  
  20. Terwee C, Wakelkamp I, Tan S, Dekker F, Prummel MF, Wiersinga W. Long-term effects of Graves’ ophthalmopathy on health-related quality of life. Eur J Endocrinol 2002; 146(6): 751-7. PubMed  
  21. Bartley GB, Fatourechi V, Kadrmas EF, Jacobsen SJ, Ilstrup DM, Garrity JA, et al. Long-term follow-up of Graves ophthalmopathy in an incidence cohort. Ophthalmology 1996; 103(6): 958-62. PubMed  
  • Anders Behndig, professor och överläkare, Ögonkliniken, Norrlands universitetssjukhus, Umeå
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet