Thyroid-Associated Ophthalmopathy

Abstract

Thyroid-related immune orbitopathy (TRIO) has a variety of names previously, such as Graves’ ophthalmopathy, ophthalmic Graves’ disease, and thyroid-associated ocular disease. Although their names are different, their clinical characteristics are the same, that is, abnormal thyroid endocrine axis (endocrine hormones secreted by the thyroid, pituitary, and hypothalamus or their interactions), and they have similar orbital lesions. We will have a lot of confusion in clinical practice if we analyze problems from the single perspective of ophthalmologists. For example, some patients are without any abnormalities upon thyroid function examination and imaging examination, but their exophthalmos and eyelid anomaly are very typical, so how to diagnose and treat such patients? Why have similar treatments produced entirely different effects in different patients having similar clinical manifestations? Why have the eye symptoms and signs worsened after surgery in some patients? For patients with unstable thyroid function and obvious ocular signs, how should we make the choice between ophthalmology and internal medicine? Through combining the holistic integrative medicine thinking with the disease characteristics of TRIO, we realize that, for some minor thyroid-associated ophthalmopathies with normal thyroid function, we should be wary of the wrong thinking that “laboratory test can replace clinical diagnosis” and should pay attention to the clinical manifestations and characteristic eyelid symptoms, and test results cannot be regarded as the gold standard for diagnosis; when determining the internal medicine regimen for conditions accompanied by abnormal thyroid function, we should, in addition to making active attempts to treat the primary disease, realize that hastily decreasing thyroid function indicators with the internal medicine treatment iodine treatment may lead to the aggravation of ocular signs; in different individuals and at different stages of the disease, the systemic or ocular changes of TRIO will be different, which will make the results difficult to quantify. The principle of individualization should also be followed when standardization of TRIO treatment is pursued. Therefore, the diagnosis and treatment of TRIO should take into account both, and the endocrine and ophthalmic departments should cooperate to make an individualized comprehensive treatment regimen.