Management of thyroid ophthalmopathy: the approach and challenges

Thyroid ophthalmopathy, or Graves’ ophthalmopathy, is the most common cause of exophthalmos in adults. Graves first described thyroid disease with associated ophthalmopathy in 1835. To date, the pathogenesis of thyroid ophthalmopathy remains speculative, as reflected by the numerous names by which it is described such as dysthyroid ophthalmopathy or thyroid eye disease, thyroid orbitopathy, euthyroid ophthalmopathy, euthyroid Graves’ disease, thyrotoxic exophthalmos, infiltrative ophthalmopathy, or malignant exophthalmos. It is considered to be an organspecific autoimmune disease, strongly associated with Graves’ hyperthyroidism. For some patients, thyroid function may remain normal or subnormal for part or all of the course of the disease. Some evidence indicates that radioiodine ablation, surgical thyroidectomy, or hypothyroidism after medical treatment can initiate or exacerbate thyroid eye disease. Smoking has also been shown to be a risk factor for developing more severe ophthalmopathy.