Orbital diseases mimicking graves ’ orbitopathy: a long-standing challenge in differential diagnosis

AbstractGraves ’ orbitopathy (GO) is the most common cause of orbital tissue inflammation, accounting for ~ 60% of all orbital inflammatory conditions in the population aged 21–60 years, and for ~ 40% in the population aged >  60 year. GO is observed in 25–30% of patients with Graves’ hyperthyroidism and more rarely in association with hypothyroid autoimmune thyroiditis. In addition, a small proportion of GO patients (1–2%) do not have a clinically overt thyroid dysfunction. Clinically, GO is characterized by pr optosis, inflammation involving the eyelids and the conjunctiva, extraocular muscle hypertrophy, with consequent reduction of ocular motility and diplopia, and in the most severe cases, compression of the optic nerves at the orbital apex, with reduction of visual acuity. At CT scan or MRI, a muscle increase involving the superior, medial and inferior rectus is quite typical. In the most severe forms, compression of the optic nerves at the orbital apex can be observed. Euthyroid GO is usually an early sign of a full-blown Graves’ disease; however, in some cases, the orbital disease can remain isolated. Moreover, euthyroid GO can rarely be unilateral, which makes the picture even more confusing. Under those circumstances, the diagnostic process becomes obviously quite difficult, having other conditions mimicking GO been excluded. A number of inflammatory conditions affecting orbital tiss ue can mimic GO, thereby requiring an accurate evaluat...
Source: Journal of Endocrinological Investigation - Category: Endocrinology Source Type: research