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Erschienen in: Der Ophthalmologe 4/2016

01.04.2016 | Morbus Basedow | CME

Endokrine Orbitopathie

verfasst von: Prof. Dr. A. Eckstein, D. Dekowski, D. Führer-Sakel, U. Berchner-Pfannschmidt, J. Esser

Erschienen in: Die Ophthalmologie | Ausgabe 4/2016

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Zusammenfassung

Die endokrine Orbitopathie ist die häufigste extrathyroidale Manifestation der Basedow-Erkrankung und kann im Vollbild die Lebensqualität erheblich beeinträchtigen. Unter antientzündlicher Therapie flaut die Entzündung zwar häufig ab, permanente Defekte lassen sich aber dadurch nicht vermeiden, da es durch die Inflammationsreaktion der orbitalen Fibrozyten relativ schnell zu irreversiblen Vernarbungsprozessen kommt. Wichtig ist die Prävention schwerer Verläufe durch Nikotinkarenz, gute Kontrolle der Schilddrüsenfunktion und Selensupplementation. Orbita-, Lid- und Augenmuskelchirurgie sind bei schweren Verläufen oft die einzige Möglichkeit, die gestörte Sehfunktion und das veränderte Aussehen wiederherzustellen. Spezifisch ist das Auftreten von Anti-TSH-Rezeptor-Antikörpern (TSH: Thyreoidea – stimulierendes Hormon, Thyreotropin), deren Spiegel mit dem Verlauf der Orbita- sowie der Schilddrüsenerkrankung assoziiert sind und deshalb zu bestimmten Zeitpunkten der Erkrankungen in Therapieentscheidungen einbezogen werden können.
Literatur
1.
Zurück zum Zitat Kahaly GJ, Petrak F, Hardt J, Pitz S et al (2005) Psychosocial morbidity of Graves’ orbitopathy. Clin Endocrinol (Oxf) 63(4):395–402CrossRef Kahaly GJ, Petrak F, Hardt J, Pitz S et al (2005) Psychosocial morbidity of Graves’ orbitopathy. Clin Endocrinol (Oxf) 63(4):395–402CrossRef
2.
Zurück zum Zitat Banga JP, Moshkelgosha S, Berchner-Pfannschmidt U, Eckstein A (2015) Modeling Graves’ orbitopathy in experimental Graves’ disease. Horm Metab Res 47(10):e4CrossRef Banga JP, Moshkelgosha S, Berchner-Pfannschmidt U, Eckstein A (2015) Modeling Graves’ orbitopathy in experimental Graves’ disease. Horm Metab Res 47(10):e4CrossRef
4.
Zurück zum Zitat Wiersinga WM, Perros P, Kahaly GJ, Mourits MP et al (2006) Clinical assessment of patients with Graves’ orbitopathy: the European group on Graves’ orbitopathy recommendations to generalists, specialists and clinical researchers. Eur J Endocrinol 155(3):387–389CrossRefPubMed Wiersinga WM, Perros P, Kahaly GJ, Mourits MP et al (2006) Clinical assessment of patients with Graves’ orbitopathy: the European group on Graves’ orbitopathy recommendations to generalists, specialists and clinical researchers. Eur J Endocrinol 155(3):387–389CrossRefPubMed
5.
Zurück zum Zitat Eckstein A, Loesch C, Glowacka D, Schott M et al (2009) Euthyroid and primarily hypothyroid patients develop milder and significantly more asymmetric Graves ophthalmopathy. Br J Ophthalmol 93:1052–1056CrossRefPubMed Eckstein A, Loesch C, Glowacka D, Schott M et al (2009) Euthyroid and primarily hypothyroid patients develop milder and significantly more asymmetric Graves ophthalmopathy. Br J Ophthalmol 93:1052–1056CrossRefPubMed
6.
Zurück zum Zitat Traisk F, Tallstedt L, Abraham-Nordling M, Andersson T et al (2009) Thyroid-associated ophthalmopathy after treatment for Graves’ hyperthyroidism with antithyroid drugs or iodine-131. J Clin Endocrinol Metab 94(10):3700–3707CrossRefPubMed Traisk F, Tallstedt L, Abraham-Nordling M, Andersson T et al (2009) Thyroid-associated ophthalmopathy after treatment for Graves’ hyperthyroidism with antithyroid drugs or iodine-131. J Clin Endocrinol Metab 94(10):3700–3707CrossRefPubMed
7.
Zurück zum Zitat Hegedius L, Brix TH, Vestergaard P (2004) Relationship between cigarette smoking and Graves’ ophthalmopathy. J Endocrinol Invest 27(3):265–271CrossRefPubMed Hegedius L, Brix TH, Vestergaard P (2004) Relationship between cigarette smoking and Graves’ ophthalmopathy. J Endocrinol Invest 27(3):265–271CrossRefPubMed
8.
Zurück zum Zitat Leo M, Marcocci C, Pinchera A, Nardi M et al (2012) Outcome of Graves’ orbitopathy after total thyroid ablation and glucocorticoid treatment: follow-up of a randomized clinical trial. J Clin Endocrinol Metab 97(1):E44–E48CrossRefPubMed Leo M, Marcocci C, Pinchera A, Nardi M et al (2012) Outcome of Graves’ orbitopathy after total thyroid ablation and glucocorticoid treatment: follow-up of a randomized clinical trial. J Clin Endocrinol Metab 97(1):E44–E48CrossRefPubMed
9.
Zurück zum Zitat Hegedus L, Bonnema SJ, Smith TJ, Brix TH (2012) Treating the thyroid in the presence of Graves’ ophthalmopathy. Best Pract Res Clin Endocrinol Metab 26(3):313–324CrossRefPubMed Hegedus L, Bonnema SJ, Smith TJ, Brix TH (2012) Treating the thyroid in the presence of Graves’ ophthalmopathy. Best Pract Res Clin Endocrinol Metab 26(3):313–324CrossRefPubMed
10.
Zurück zum Zitat Eckstein A, Mann K, Kahaly GJ, Grussendorf M et al (2009) Role of TSH receptor autoantibodies for the diagnosis of Graves’ disease and for the prediction of the course of hyperthyroidism and ophthalmopathy. Recommendations of the Thyroid Section of the German Society of Endocrinology. Med Klin (munich) 104(5):343–348CrossRef Eckstein A, Mann K, Kahaly GJ, Grussendorf M et al (2009) Role of TSH receptor autoantibodies for the diagnosis of Graves’ disease and for the prediction of the course of hyperthyroidism and ophthalmopathy. Recommendations of the Thyroid Section of the German Society of Endocrinology. Med Klin (munich) 104(5):343–348CrossRef
11.
Zurück zum Zitat Eckstein AK, Lax H, Losch C, Glowacka D et al (2007) Patients with severe Graves’ ophthalmopathy have a higher risk of relapsing hyperthyroidism and are unlikely to remain in remission. Clin Endocrinol (Oxf) 67(4):607–612 Eckstein AK, Lax H, Losch C, Glowacka D et al (2007) Patients with severe Graves’ ophthalmopathy have a higher risk of relapsing hyperthyroidism and are unlikely to remain in remission. Clin Endocrinol (Oxf) 67(4):607–612
12.
Zurück zum Zitat Perros P, Kendall-Taylor P (1998) Natural history of thyroid eye disease. Thyroid 8(5):423–425CrossRefPubMed Perros P, Kendall-Taylor P (1998) Natural history of thyroid eye disease. Thyroid 8(5):423–425CrossRefPubMed
13.
Zurück zum Zitat Bartalena L, Baldeschi L, Dickinson A, Eckstein A et al (2008) Consensus statement of the European group on Graves’ orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol 158(3):273–285CrossRefPubMed Bartalena L, Baldeschi L, Dickinson A, Eckstein A et al (2008) Consensus statement of the European group on Graves’ orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol 158(3):273–285CrossRefPubMed
14.
Zurück zum Zitat Marcocci C, Kahaly GJ, Krassas GE, Bartalena L et al (2011) Selenium and the course of mild Graves’ orbitopathy. N Engl J Med 364(20):1920–1931CrossRefPubMed Marcocci C, Kahaly GJ, Krassas GE, Bartalena L et al (2011) Selenium and the course of mild Graves’ orbitopathy. N Engl J Med 364(20):1920–1931CrossRefPubMed
15.
Zurück zum Zitat Stiebel-Kalish H, Robenshtok E, Hasanreisoglu M, Ezrachi D et al (2009) Treatment modalities for Graves’ ophthalmopathy: systematic review and metaanalysis. J Clin Endocrinol Metab 94(8):2708–2716CrossRefPubMed Stiebel-Kalish H, Robenshtok E, Hasanreisoglu M, Ezrachi D et al (2009) Treatment modalities for Graves’ ophthalmopathy: systematic review and metaanalysis. J Clin Endocrinol Metab 94(8):2708–2716CrossRefPubMed
16.
Zurück zum Zitat Kahaly GJ, Pitz S, Hommel G, Dittmar M (2005) Randomized, single blind trial of intravenous versus oral steroid monotherapy in Graves’ orbitopathy. J Clin Endocrinol Metab 90(9):5234–5240CrossRefPubMed Kahaly GJ, Pitz S, Hommel G, Dittmar M (2005) Randomized, single blind trial of intravenous versus oral steroid monotherapy in Graves’ orbitopathy. J Clin Endocrinol Metab 90(9):5234–5240CrossRefPubMed
17.
Zurück zum Zitat Bartalena L, Krassas GE, Wiersinga W, Marcocci C et al (2012) Efficacy and safety of three different cumulative doses of intravenous methylprednisolone for moderate to severe and active Graves’ orbitopathy. J Clin Endocrinol Metab 97(12):4454–4463CrossRefPubMed Bartalena L, Krassas GE, Wiersinga W, Marcocci C et al (2012) Efficacy and safety of three different cumulative doses of intravenous methylprednisolone for moderate to severe and active Graves’ orbitopathy. J Clin Endocrinol Metab 97(12):4454–4463CrossRefPubMed
18.
Zurück zum Zitat Zang S, Ponto KA, Kahaly GJ (2011) Clinical review: Intravenous glucocorticoids for Graves’ orbitopathy: efficacy and morbidity. J Clin Endocrinol Metab 96(2):320–332CrossRefPubMed Zang S, Ponto KA, Kahaly GJ (2011) Clinical review: Intravenous glucocorticoids for Graves’ orbitopathy: efficacy and morbidity. J Clin Endocrinol Metab 96(2):320–332CrossRefPubMed
19.
Zurück zum Zitat Mourits MP, van Kempen-Harteveld ML, Garcia MB, Koppeschaar HP et al (2000) Radiotherapy for Graves’ orbitopathy: randomised placebo-controlled study. Lancet 355(9214):1505–1509CrossRefPubMed Mourits MP, van Kempen-Harteveld ML, Garcia MB, Koppeschaar HP et al (2000) Radiotherapy for Graves’ orbitopathy: randomised placebo-controlled study. Lancet 355(9214):1505–1509CrossRefPubMed
20.
Zurück zum Zitat Garrity JA, Fatourechi V, Bergstralh EJ, Bartley GB et al (1993) Results of transantral orbital decompression in 428 patients with severe Graves’ ophthalmopathy. Am J Ophthalmol 116(5):533–547CrossRefPubMed Garrity JA, Fatourechi V, Bergstralh EJ, Bartley GB et al (1993) Results of transantral orbital decompression in 428 patients with severe Graves’ ophthalmopathy. Am J Ophthalmol 116(5):533–547CrossRefPubMed
21.
Zurück zum Zitat Salvi M, Vannucchi G, Curro N, Campi I et al (2015) Efficacy of B‑cell targeted therapy with rituximab in patients with active moderate to severe graves’ orbitopathy: a randomized controlled study. J Clin Endocrinol Metab 100(2):422–431CrossRefPubMedPubMedCentral Salvi M, Vannucchi G, Curro N, Campi I et al (2015) Efficacy of B‑cell targeted therapy with rituximab in patients with active moderate to severe graves’ orbitopathy: a randomized controlled study. J Clin Endocrinol Metab 100(2):422–431CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Stan MN, Garrity JA, Carranza Leon BG, Prabin T et al (2015) Randomized controlled trial of rituximab in patients with graves’ orbitopathy. J Clin Endocrinol Metab 100(2):432–441CrossRefPubMedPubMedCentral Stan MN, Garrity JA, Carranza Leon BG, Prabin T et al (2015) Randomized controlled trial of rituximab in patients with graves’ orbitopathy. J Clin Endocrinol Metab 100(2):432–441CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Kahaly G, Schrezenmeir J, Krause U, Schweikert B et al (1986) Ciclosporin and prednisone v. prednisone in treatment of Graves’ ophthalmopathy: a controlled, randomized and prospective study. Eur J Clin Invest 16(5):415–422CrossRefPubMed Kahaly G, Schrezenmeir J, Krause U, Schweikert B et al (1986) Ciclosporin and prednisone v. prednisone in treatment of Graves’ ophthalmopathy: a controlled, randomized and prospective study. Eur J Clin Invest 16(5):415–422CrossRefPubMed
24.
Zurück zum Zitat Terwee CB, Prummel MF, Gerding MN, Kahaly GJ et al (2005) Measuring disease activity to predict therapeutic outcome in Graves’ ophthalmopathy. Clin Endocrinol (Oxf) 62(2):145–155CrossRef Terwee CB, Prummel MF, Gerding MN, Kahaly GJ et al (2005) Measuring disease activity to predict therapeutic outcome in Graves’ ophthalmopathy. Clin Endocrinol (Oxf) 62(2):145–155CrossRef
25.
Zurück zum Zitat Curro N, Covelli D, Vannucchi G, Campi I et al (2014) Therapeutic outcomes of high-dose intravenous steroids in the treatment of dysthyroid optic neuropathy. Thyroid 24(5):897–905CrossRefPubMed Curro N, Covelli D, Vannucchi G, Campi I et al (2014) Therapeutic outcomes of high-dose intravenous steroids in the treatment of dysthyroid optic neuropathy. Thyroid 24(5):897–905CrossRefPubMed
26.
Zurück zum Zitat Wabbels B, Forl M (2007) Botulinum toxin treatment for crocodile tears, spastic entropion and for dysthyroid upper eyelid retraction. Ophthalmologe 104(9):771–776CrossRefPubMed Wabbels B, Forl M (2007) Botulinum toxin treatment for crocodile tears, spastic entropion and for dysthyroid upper eyelid retraction. Ophthalmologe 104(9):771–776CrossRefPubMed
27.
Zurück zum Zitat Eckstein A, Schittkowski M, Esser J (2012) Surgical treatment of Graves’ ophthalmopathy. Best practice & research. Clin Endocrinol Metab 26(3):339–358 Eckstein A, Schittkowski M, Esser J (2012) Surgical treatment of Graves’ ophthalmopathy. Best practice & research. Clin Endocrinol Metab 26(3):339–358
29.
Zurück zum Zitat Baldeschi L (2010) Small versus coronal incision orbital decompression in Graves’ orbitopathy. Orbit 29(4):177–182CrossRefPubMed Baldeschi L (2010) Small versus coronal incision orbital decompression in Graves’ orbitopathy. Orbit 29(4):177–182CrossRefPubMed
30.
Zurück zum Zitat Eckstein A, Esser J (2015) Surgical management of extraocular muscle dysfunction in patients with GO. In: Bahn RS (Hrsg) Graves’ Disease. Springer Science+Business Media, New York Eckstein A, Esser J (2015) Surgical management of extraocular muscle dysfunction in patients with GO. In: Bahn RS (Hrsg) Graves’ Disease. Springer Science+Business Media, New York
31.
Zurück zum Zitat Esser J, Eckstein A (1999) Ocular muscle and eyelid surgery in thyroid-associated orbitopathy. Exp Clin Endocrinol Diabetes 107(Suppl 5):S214–S221CrossRefPubMed Esser J, Eckstein A (1999) Ocular muscle and eyelid surgery in thyroid-associated orbitopathy. Exp Clin Endocrinol Diabetes 107(Suppl 5):S214–S221CrossRefPubMed
32.
Zurück zum Zitat Neoh C, Eckstein A (2010) Eyelid surgery. In: Wiersinga WM, Kahaly GJ (Hrsg) Graves’ orbitopathy: a multidisciplinary approach – questions and answers. Karger, Basel, S 200–210CrossRef Neoh C, Eckstein A (2010) Eyelid surgery. In: Wiersinga WM, Kahaly GJ (Hrsg) Graves’ orbitopathy: a multidisciplinary approach – questions and answers. Karger, Basel, S 200–210CrossRef
33.
Zurück zum Zitat Eckstein A, Berchner-Pfannenschmidt U, Führer D, Esser J (2013) Update endokrine Orbitopathie. Ophthalmologe 110(10):1079–1096CrossRefPubMed Eckstein A, Berchner-Pfannenschmidt U, Führer D, Esser J (2013) Update endokrine Orbitopathie. Ophthalmologe 110(10):1079–1096CrossRefPubMed
Metadaten
Titel
Endokrine Orbitopathie
verfasst von
Prof. Dr. A. Eckstein
D. Dekowski
D. Führer-Sakel
U. Berchner-Pfannschmidt
J. Esser
Publikationsdatum
01.04.2016
Verlag
Springer Berlin Heidelberg
Schlagwort
Morbus Basedow
Erschienen in
Die Ophthalmologie / Ausgabe 4/2016
Print ISSN: 2731-720X
Elektronische ISSN: 2731-7218
DOI
https://doi.org/10.1007/s00347-016-0239-3

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