Graves' orbitopathy: Diagnosis and treatment.
(2018) Annales d’endocrinologie — Vol. 79, n° 6, p. 656-664 (2018)
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- Abstract
- 1. Clinical assessment of Graves’ orbitopathy Graves’ orbitopathy (GO) is the most frequent extrathyroid complication in Graves’ disease. Natural history, described by Rundle, features an initial inflammatory or active phase in which acute episodes and spontaneous remissions alternate, then a fibrotic phase, with regression within 12–18 months. Diagnosis is based on symptoms and ocular signs. Clinical examination must therefore be rigorous; in case of doubt, the ophthalmologist's opinion is determining. Various classifications assess clinical signs: most widely used are the EUGOGO (European Group Of Graves’ Orbitopathy) and VISA (Vision, Inflammation, Strabismus, Appearance) classifications, the former (http://www.eugogo.eu.proxy.bib.ucl.ac.be) in Europe and the latter (http://www.thyroideyedisease.org.proxy.bib.ucl.ac.be) more often in the US and Canada. Both have limitations; they are not interchangeable, and each patient must consistently be monitored on one or the other. Expert discussions are ongoing, and alternative classifications are offered to improve assessment [1], [2]. Delayed diagnosis and treatment impair ocular progression [3]. Optimal treatment depends on activity status and severity [4]. Clinical activity score (CAS) ≥3/7 indicates active status. Severity is graded as mild, moderate-to-severe or very severe (sight-threatening). Table 1 shows activity and severity criteria. [...]
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Citations
Drui, D., Du Pasquier Fediaevski, L., Vignal Clermont, C., & Daumerie, C. (2018). Graves’ orbitopathy: Diagnosis and treatment. Annales d’endocrinologie, 79(6), 656-664. https://doi.org/10.1016/j.ando.2018.08.005 (Original work published 2018)