Suplement do nr-u 1/2003
Zmiany oczne u pacjentów z chorobą Gravesa przebiegającą z eutyreozą
Ocular changes in patients with euthyroid Graves' disease
Jadwiga Janik1, Helena Jastrzębska2, Małgorzata Gietka-Czernel2, Stefan Zgliczyński2, Barbara Rożniatowska3, Jerzy Elbanowski4
1Poradnia Okulistyczna i 2Klinika Endokrynologii
Centrum Medycznego Kształcenia Podyplomowego w Warszawie
Kierownik: prof. dr hab. med. Stefan Zgliczyński
3Zakład Radiologii i Pracownia Tomografii Komputerowej
Szpitala Bielańskiego w Warszawie
Kierownik: lek. med. Krzysztof Lerch
4Zakład Informatyki Centrum Medycznego
Kształcenia Podyplomowego w Warszawie
Kierownik: dr med. Włodzimierz Borkowski
Summary: Purpose: Evaluation of ocular changes in patients with euthyroid Graves' disease. Material and methods: The study involved 15 patients (30 eyes) with Graves' disease which was not accompanied by hyperthyroidism. The mean patients' age was 49,27?8,17 years (aged 39 to 66 years); 10 woman and 5 men. Fifteen normal subjects (30 eyes), mean age 48,73?7,83, served as controls. In all complete ophthalmological examination, exophthalmometry, tonometry and computed static perimetry (Octopus 1-2-3 Interzeag, G1X program) were performed. All orbits were CT scanned in both axial and direct coronal planes with the use of ELSCINT SPRINT 2000. Ocular changes were classified according to the NOSPECS system. Results: Antithyroglobulin and/or antimicrosomal antibodes and goitre were present in all patients with euthyroid Graves' disease. Ocular changes in these patients were classified according to the NOSPECS system as: 2a and b, 3a, 4a and b, 6a; no class 5 changes were found. Proptosis in this group was clearly asymmetric (statistically significant, p<0,0001) with mean value of 18,07?2,02. Intraocular pressure did not differ significantly between the patients with euthyroid Graves' disease and the normal subjects (p=0,597). Enlargement of extraocular muscles was found in 11 (36,7%) orbits with euthyroid Graves' disease. In 8 (72,7%) of these 11 affected orbits, the muscle enlargement was unilateral. The inferior rectus muscle was most frequently affected - 7 cases (23,3%) and the lateral rectus was the least frequently affected muscle - 1 case (3,3%). Conclusions: 1. An association was observed between ocular changes and the presence of antithyroglobulin and/or antimicrosomal antibodies and goitre. 2. The changes in soft tissue were mild or moderate; no large proptosis or corneal damage were found. 3. The most frequent finding was asymmetry of ocular change, especially seen in proptosis and extraocular muscles.
Słowa kluczowe: euthyroid Graves' disease, ocular changes, extraocular muscles (CT).