Federal clinical recommendations on diagnostics and treatment of endocrine ophthalmopathy associated with autoimmune thyroid pathology

Endocrine ophthalmopathy (EOP) is a multidisciplinary problem at the intersection of endocrinology and ophthalmology. The patients presenting with this condition experience deficit of adequate medical aid due to the poor cooperation between ophthalmologists and endocrinologists. There are practically no specialized centres in this country where the patients with EOP could receive the combined treatment of this pathology including the surgical intervention. Taken together, late diagnostics and delayed seeking the efficacious medical assistance, the absence of stable compensation of the functional disorders of the thyroid gland, erroneous identification of the phase of the disease, and incorrect choice of the methods for its treatment, the lack of coordination and consistency in the actions of ophthalmologists and endocrinologists are responsible for the low effectiveness of EOP treatment. On the other hand, the absence of the unified approach to diagnostics and treatment of endocrine ophthalmopathy, the necessity of introducing the international experience gained in this field into the routine clinical practice and pooling efforts of representatives of different medical disciplines (endocrinologists, ophthalmologists, radiologists, endocrine surgeons, and neurosurgeons) created the prerequisites for the solution of the EOP problems and gave impetus to the development of the recommendations being proposed.

endocrine ophthalmopathy, diffuse toxic goiter

1. Бровкина А.Ф. Патогенез оптической нейропатии при отечном экзофтальме. // Вестник Офтальмологии. - 2009. - Т. 125. - №4. - С. 30-32.

2. Бровкина А.Ф. Эндокринная офтальмопатия. - М.: ГЭОТАР-Медиа; 2008. - 178 с.

3. Дедов И.И., Мельниченко Г.А., Фадеев В.В. Эндокринология. - М.: ГЭОТАР-Медиа; 2009. - 422 с.

4. Дедов И.И., Мельниченко Г.А., Фадеев В.В. Эндокринология. - M.: Медицина; 2000. - С. 172-179.

5. Мельниченко Г.А. Болезни щитовидной железы и беременность. В кн.: Болезни органов эндокринной системы (руководство по внутренним болезням). / Под ред. И.И. Дедова. - М.: Медицина; 2002.

6. Пантелеева О.Г. Современная концепция механизма развития нарушений зрительных функций при эндокринной офтальмопатии. Автореф. дисс. … докт.мед.наук. - М.; 2007. 47с.

7. Пантелеева О.Г., Куроедов А.В., Шамшинова А.М., Саакян С.В., Романова Е.В., Пономарева Е.Н. Морфофункциональные характеристики сетчатки и зрительного нерва при эндокринной офтальмопатии. // Вестник офтальмологии. - 2006. - Т. 122. - №4. - С. 25-28.

8. Свириденко Н.Ю., Беловалова И.М., Шеремета М.С., Табеева К.И., Ремизов О.В. Болезнь Грейвса и эндокринная офтальмопатия. / Под редакцией академика РАН и РАМН И.И. Дедова и академика РАМН Г.А. Мельниченко. - М.: МАИ-принт; 2012. - 143 с.

9. Свириденко Н.Ю., Лихванцева В.Г., Беловалова И.М., Шеремета М.С., Табеева К.И. Антитела к рецептору ТТГ как предикторы тяжести и исходов эндокринной офтальмопатии у пациентов с болезнью Грейвса. // Проблемы эндокринологии. - 2011. - Т. 57. - №2. - С. 23-26. doi: 10.14341/probl201157223-26.

10. Свириденко Н.Ю., Шеремета М.С., Беловалова И.М., Гарбузов П.И., Чепурина А.А., Гончаров М.П. Клиническое течение эндокринной офтальмопатии после радиойодтерапии болезни Грейвса. // Мiжнародний Ендокринологiчний Журнал. - 2012. - №2. - С. 118-121.

11. Сирмайс О.С. Клинико-диагностические критерии и причины развития рефрактерных форм эндокринной офтальмопатии. Автореф. дисс.. канд.мед.наук. М.; 2013. - 24 с.

12. Фадеев В.В., Абрамова Н.А., Прокофьев С.А., Гитель Е.П., Мельниченко Г.А., Дедов И.И. Антитела к рецептору тиреотропного гормона в дифференциальной диагностике токсического зоба. // Проблемы эндокринологии. - 2005. - Т. 51. - №4. - С. 10-18.

13. Фадеев В.В., Дроздовский Б.Я., Гарбузов П.И., Гарбузов П.И., Бузиашвили И.И., Мельниченко Г.А. Отдаленные результаты лечения токсического зоба радиоактивным 131I. // Проблемы эндокринологии. - 2005. - Т. 51. - №1. - С. 3-9.

14. Шеремета М.С., Свириденко Н.Ю., Ремизов О.В., Лихванцева В.Г., Беловалова И.М., Бухман А.И., и др. Клинико-рентгенологические взаимоотношения при эндокринной офтальмопатии. // Клиническая и экспериментальная тиреоидология. - 2009. - Т. 5. - №1. - С. 53-57. doi: 10.14341/ket20095153-57.

15. Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21(6):593-646. doi: 10.1089/thy.2010.0417.

16. Bartalena L, Tanda ML, Piantanida E, Lai A, Pinchera A. Relationship between management of hyperthyroidism and course of the ophthalmopathy. Journal of Endocrinological Investigation. 2014;27(3):288-294. doi: 10.1007/bf03345279.

17. Bartalena L, Tanda ML, Piantanida E, Lai A. Glucocorticoids and outcome of radioactive iodine therapy for Graves’ hyperthyroidism. European Journal of Endocrinology. 2005;153(1):13-14. doi: 10.1530/eje.1.01938.

18. Cawood TJ, Moriarty P, O’Farrelly C, O’Shea D. Smoking and Thyroid-Associated Ophthalmopathy: A Novel Explanation of the Biological Link. The Journal of Clinical Endocrinology & Metabolism. 2007;92(1):59-64. doi: 10.1210/jc.2006-1824.

19. De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, et al. Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism. 2012;97(8):2543-2565. doi: 10.1210/jc.2011-2803.

20. Eckstein AK, Plicht M, Lax H, Neuhäuser M, Mann K, Lederbogen S, et al. Thyrotropin Receptor Autoantibodies Are Independent Risk Factors for Graves’ Ophthalmopathy and Help to Predict Severity and Outcome of the Disease. The Journal of Clinical Endocrinology & Metabolism. 2006;91(9):3464-3470. doi: 10.1210/jc.2005-2813.

21. Esfahani AF, Kakhki VR, Fallahi B, Eftekhari M, Beiki D, Saghari M, et al. Comparative evaluation of two fixed doses of 185 and 370 MBq 131I, for the treatment of Graves’ disease resistant to antithyroid drugs. Hellenic Journal of Nuclear Medicine. 2005;8(3):158-161. PMID: 16390021.

22. Feldon SE. Quantitative Computed Tomography of Graves’ Ophthalmopathy. Archives of Ophthalmology. 1985;103(2):213. doi: 10.1001/archopht.1985.01050020065021.

23. Ginsberg J. Diagnosis and management of Graves’ disease. Canadian Medical Association Journal. 2003;168(5):575-585. PMID: 12615754.

24. Järhult J, Rudberg C, Larsson E, Selvander H, Sjövall K, Winsa B, et al. Graves’ Disease with Moderate-Severe Endocrine Ophthalmopathy-Long Term Results of a Prospective, Randomized Study of Total or Subtotal Thyroid Resection. Thyroid. 2005;15(10):1157-1164. doi: 10.1089/thy.2005.15.1157.

25. Lal G, Ituarte P, Kebebew E, Siperstein A, Duh Q-Y, Clark OH. Should Total Thyroidectomy Become the Preferred Procedure for Surgical Management of Graves’ Disease? Thyroid. 2005;15(6):569-574. doi: 10.1089/thy.2005.15.569.

26. Le Moli R, Baldeschi L, Saeed P, Regensburg N, Mourits MP, Wiersinga WM. Determinants of Liver Damage Associated with Intravenous Methylprednisolone Pulse Therapy in Graves’ Ophthalmopathy. Thyroid. 2007;17(4):357-362. doi: 10.1089/thy.2006.0267.

27. Lennerstrand G, Tian S, Isberg B, Landau Högbeck I, Bolzani R, Tallstedt L, et al. Magnetic resonance imaging and ultrasound measurements of extraocular muscles in thyroid-associated ophthalmopathy at different stages of the disease. Acta Ophthalmologica Scandinavica. 2007;85(2):192-201. doi: 10.1111/j.1600-0420.2006.00807.x.

28. The Use of Antithyroid Drugs in Pregnancy and Lactation. The Journal of Clinical Endocrinology & Metabolism. 2001;86(6):2354-2359. doi: 10.1210/jcem.86.6.7573.

29. Manji N, Carr-Smith JD, Boelaert K, Allahabadia A, Armitage M, Chatterjee VK, et al. Influences of Age, Gender, Smoking, and Family History on Autoimmune Thyroid Disease Phenotype. The Journal of Clinical Endocrinology & Metabolism. 2006;91(12):4873-4880. doi: 10.1210/jc.2006-1402.

30. Marcocci, Bruno B, Manetti, Tanda, Miccolio, Iacconi, et al. The course of Graves’ ophthalmopathy is not influenced by near total thyroidectomy: a case-control study. Clinical Endocrinology. 1999;51(4):503-508. doi: 10.1046/j.1365-2265.1999.00843.x.

31. Marinó M, Morabito E, Brunetto MR, Bartalena L, Pinchera A, Marocci C. Acute and Severe Liver Damage Associated with Intravenous Glucocorticoid Pulse Therapy in Patients with Graves’ Ophthalmopathy. Thyroid. 2004;14(5):403-406. doi: 10.1089/105072504774193276.

32. McKeag D, Lane C, Lazarus JH, Baldeschi L, Boboridis K, Dickinson AJ, et al. Clinical features of dysthyroid optic neuropathy: a European Group on Graves’ Orbitopathy (EUGOGO) survey. British Journal of Ophthalmology. 2006;91(4):455-458. doi: 10.1136/bjo.2006.094607.

33. Menconi F, Marinò M, Pinchera A, Rocchi R, Mazzi B, Nardi M, et al. Effects of Total Thyroid AblationVersusNear-Total Thyroidectomy Alone on Mild to Moderate Graves’ Orbitopathy Treated with Intravenous Glucocorticoids. The Journal of Clinical Endocrinology & Metabolism. 2007;92(5):1653-1658. doi: 10.1210/jc.2006-1800.

34. Mourits MP, Koornneef L, Wiersinga WM, Prummel MF, Berghout A, van der Gaag R. Clinical criteria for the assessment of disease activity in Graves’ ophthalmopathy: a novel approach. British Journal of Ophthalmology. 1989;73(8):639-644. doi: 10.1136/bjo.73.8.639.

35. Nagy E, Toth J, Kaldi I, Damjanovich J, Mezosi E, Lenkey A, et al. Graves’ ophthalmopathy: eye muscle involvement in patients with diplopia. European Journal of Endocrinology. 2000;142(6):591-597. doi: 10.1530/eje.0.1420591.

36. Orgiazzi J. Pathogenesis Graves’ orbitopathy: a multidisciplinary approach. Ed by Wiersinga WM, Kahaly GJ. Basel: Karger; 2007.

37. European Group of Graves’ Orbitopathy; Perros P, Baldeschi L, Boboridis K, Dickinson AJ, et al. A questionnaire survey on the management of Graves’ orbitopathy in Europe. European Journal of Endocrinology. 2006;155(2):207-211. doi: 10.1530/eje.1.02201.

38. Prummel M, Bakker A, Wiersinga W, Baldeschi L, Mourits M, Kendall-Taylor P, et al. Multi-center study on the characteristics and treatment strategies of patients with Graves’ orbitopathy: the first European Group on Graves’ Orbitopathy experience. European Journal of Endocrinology. 2003;148(5):491-495. doi: 10.1530/eje.0.14804 91.

39. Sridama V, DeGroot LJ. Treatment of Graves’ disease and the course of ophthalmopathy. The American Journal of Medicine. 1989;87(1):70-73. doi: 10.1016/s0002-9343(89)80485-1.

40. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Thyroid. 2011;21(10):1081-1125. doi: 10.1089/thy.2011.0087.

41. Thornton J, Kelly SP, Harrison RA, Edwards R. Cigarette smoking and thyroid eye disease: a systematic review. Eye. 2006;21(9):1135-1145. doi: 10.1038/sj.eye.6702603.

42. Wallaschofski H, Orda C, Georgi P, Miehle K, Paschke R. Distinction Between Autoimmune and Non-Autoimmune Hyperthyroidism by Determination of TSH-Receptor Antibodies in Patients with the Initial Diagnosis of Toxic Multinodular Goiter. Hormone and Metabolic Research. 2001;33(8):504-507. doi: 10.1055/s-2001-16945.

43. Weetman AP. Graves’ Disease. New England Journal of Medicine. 2000;343(17):1236-1248. doi: 10.1056/nejm200010263431707.

44. Werner SC. Modification of the classification of the eye changes of Graves’ disease. American Journal of Ophthalmology. 1977;83(5):725-727. PMID: 577380.

45. Wiersinga WM, Bartalena L. Epidemiology and Prevention of Graves’ Ophthalmopathy. Thyroid. 2002;12(10):855-860. doi: 10.1089/105072502761016476.

46. European Group on Graves’Orbitopathy (EUGOGO); Wiersinga WM, Perros P, Kahaly GJ, Mourits MP, Baldeschi L, et al. Clinical assessment of patients with Graves’ orbitopathy: the European Group on Graves’ Orbitopathy recommendations to generalists, specialists and clinical researchers. European Journal of Endocrinology. 2006;155(3):387-389. doi: 10.1530/eje.1.02230.