Graves' orbitopathy: a multidisciplinary approach ; 38 tables
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2007
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| 245 | 1 | 0 | |a Graves' orbitopathy |b a multidisciplinary approach ; 38 tables |c eds.: Wilmar M. Wiersinga ... |
| 250 | |a 1. Aufl. | ||
| 264 | 1 | |a Basel [u.a.] |b Karger |c 2007 | |
| 300 | |a XIX, 260 S. |b Ill., graph. Darst. | ||
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Contents
XIII Preface
Wiersinga, W.M. (Amsterdam); Kahaly, G.J.
(Mainz)
Diagnosis and Pathogenesis
1
Clinical Manifestations
Dickinson, A.J. (Newcastle upon
Тупе)
1
What Are the Common Symptoms of Graves'Orbitopathy?
1
What Are the Common Signs of Graves 'Orbitopathy?
2
What Signs Are Unusual in Graves'Orbitopathy?
4
Are There Racial Differences in How Graves'Orbitopathy Manifests?
4
Is the Presentation of Graves'Orbitopathy Different in Older Compared to Younger
Patients?
5
Why Can the Clinical Presentation of Graves'Orbitopathy Be So Variable?
5
Can You Give Me a Short Mechanistic Explanation for All These Clinical
Manifestations?
6
What Do the Terms 'Activity' and 'Severity' Denote?
7
Why Is It Important to Distinguish Activity and Severity when Evaluating Patients?
8
What Symptoms and Signs Are Valuable for Assessing Activity?
8
How Are These Signs Assessed?
11
How Reproducible Are These Assessments?
11
What Value Does the 'Clinical Activity Score'Have?
12
Do Patients without Signs of Activity Ever Have Active Disease?
13
What Should I Do if I Am Not Sure whether the Disease Is Active?
13
Are There Any Other Ways to Evaluate Activity Other than Clinical Examination?
13
When Should These Other Methods for Assessing Activity Be Used in Routine
Clinical Practice?
14
What Signs Are Helpful for Assessing Severity?
14
What Value Does the Mnemonic 'NOSPECS'Have?
14
What Are the Relative Frequencies of Classes I-VI?
16
How Are Signs of Severity Assessed?
20
How Reproducible Are These Assessments?
20
How Do You Decide Whether a Patient Has Dysthyroid Optic Neuropathy?
22
Can Dysthyroid Optic Neuropathy Ever Be Present with Normal Vision?
22
Are Some Patients at Particular Risk?
22
What Other Assessments Are Useful in Evaluating Possible Dysthyroid Optic
Neuropathy?
23
Should These Tests Be Performed in All Patients at Every Assessment?
23
References
27
Orbit-Thyroid Relationship
Lazarus, J.H. (Cardiff); Marino, M. (Pisa)
27
Should This Condition Always Be Called Graves'Orbitopathy?
27
Does Graves Orbitopathy Occur in the Absence of Hyperthyroidism?
29
Do All Patients with Graves'Disease Have Graves Orbitopathy?
29
What Comes First in Graves'Disease? The Eye Changes or the Hyperthyroid Symptoms?
30
Do TSH Receptor Antibodies Also Cause GO?
31
Are There Any Other Extrathyroidal Manifestations of Graves'Disease Apart from
Graves
'
Orbitopathy?
32
References
34
Epidemiology
Daumerie, C. (Brussels); Kalmann, R. (Utrecht)
34
What Is the Present Estimated Prevalence of Graves' Orbitopathy? Has It Changed
over the Last Decade?
35
Is the Age and Sex Distribution of Graves'Orbitopathy Similar to that of Graves'
Disease?
35
Are There Ethnic Differences?
35
What Are the Risk Factors for the Occurrence of Graves' Orbitopathy?
36
Is Tobacco Bad for Graves' Orbitopathy?
37
Is Ocular Co-Morbidity Relevant for Graves'Orbitopathy?
37
Is Elevated Intraocular Pressure Relevant in Graves'Orbitopathy?
38
Is There Significant Non-Ocular Co-Morbidity (Like Diabetes) which Is Relevant
for Graves' Orbitopathy?
39
References
41
Pathogenesis
Orgiazzi, J.
(Lyon)
41
What Are the Pathological Changes in Orbital Tissue of Graves' Orbitopathy?
44
How Do the Pathological Changes Give Rise to the Clinical Manifestations?
45
What Triggers Graves'Orbitopathy?
46
Is Graves' Orbitopathy Triggered by an Autoimmune Phenomenon? If so, what Is the
Nature of the Auto-Antigen?
Contents VI
47
Why Is the Orbit a Special Target for Thyroid Autoimmunity?
48
What Kind of Immune Reaction Takes Place within the Orbit?
50
Do Anti-TSH Receptor Antibodies (TRAb) Play a Role in the Onset or Development
of Graves'Orbitopathy?
50
Is There a Familial Predisposition to Graves' Orbitopathy? Is There a Specific Genetic
Background for Graves' Orbitopathy?
51
Smoking Increases the Risk of Graves Orbitopathy and Its Severity: What Is the
Mechanism for It?
52
How May the Observations Described Above and the Current Understanding of the
Disease Lead to More Effective Treatment of Graves'Orbitopathy?
54
References
57
Orbital Imaging
Pitz, S. (Mainz)
57
Is Orbital Imaging Always Necessary?
57
What Are the Relative Benefits of Orbital CT and
MRI?
59
What Is Apical Crowding?
61
What Is the Place of Orbital Ultrasound?
62
What Lessons Can We Learn from Orbital Octreoscan?
62
What Other Imaging Techniques May Be Useful?
64
Acknowledgments
64
References
66
Diagnosis and Differential Diagnosis of Graves' Orbitopathy
Mounts, M.P. (Amsterdam)
66
Can You Give an Overall Scheme for the Diagnosis of Graves' Orbitopathy?
66
Which Clinical Findings Are Helpful in Making a Diagnosis of Graves'Orbitopathy?
70
Can One Make a Diagnosis of Graves'Orbitopathy Based on Medical History and
Clinical Picture Alone?
70
Do We Always Need to Order Thyroid Autoantibodies and Thyroid Function Tests?
71
Which Imaging Technique Is Best to Make a Diagnosis of Graves'Orbitopathy and Is
Imaging Always Requested?
72
Which Are the Most Frequent Conditions Mimicking Graves'Orbitopathy?
76
Conclusion
76
References
78
Natural History
Kendall-Taylor, P. (Newcastle upon Tyne)
78
Does Graves' Orbitopathy Occur at the Same Time as Hyperfhyroidism?
78
Does Restoring Euthyroidism Lead to Improvement in Graves'Orbitopathy?
79
What Effect May Hypothyroidism Have?
80
What Is the Typical Course of the Disease?
81
What Is the Difference between Activity and Severity?
83
How Do You Determine which Phase of the Disease the Patient Is Displaying? [see
also chapter by Dickinson, pp.
1—26]
Contents
VII
83
How Does the Phase of the Disease Influence Choice of Treatment?
84
Will the Graves'Orbitopathy Eventually Burn Itself Out?
84
Will the Orbital Changes Return to Normal when the Condition Eventually Resolves?
85
How Long Is it Likely to Take before the Disease Becomes Inactive?
85
Once the Condition Has Become Inactive (Whether Treated or Untreated) Is it Likely
to Flare Up Again?
85
Are There Any Other Factors, Additional to Thyroid Status, which May Influence the
Course of the Disease?
86
References
Management
88
General Management Plan
Boboridis, K.
(Thessaloniki);
Perros,
P. (Newcastle upon Tyne)
88
What Are the Priorities when Faced with a New Presentation of Graves'Orbitopathy?
89
How Good Is the Evidence that Quitting Smoking Helps?
89
Does Thyroid Status Affect the Eyes?
90
What Simple Measures Can Help the Eyes?
91
Is There a Place for Botulinum Toxin?
92
How Do You Define Mild, Moderately Severe, and Very Severe Graves'Orbitopathy?
92
Can You Give a Simplified Overall Management Scheme?
93
References
96
Combined Thyroid-Eye Clinics
Wiersinga, W.M. (Amsterdam)
96
What Are Combined Thyroid-Eye Clinics?
97
Why Is a Multidisciplinary Approach Recommended?
98
Can Patients-Support Groups Be Helpful?
98
I Have Heard of a Fast-Track Clinic for Graves' Orbitopathy Patients: What Is That?
99
References
100
Thyroid Treatment
Marcocci, C; Pinchera, A. (Pisa)
100
Does It Matter for the Eyes How the Patient Is Rendered Euthyroid?
103
Are There Any Specific Criteria to Prefer One of the Treatment Modalities for
Hyperthyroidism in Graves'Orbitopathy?
104
Is There Any Risk Factor which May Predict Worsening of Graves' Orbitopathy after
Radioiodine?
105
Should the Presence of Graves' Orbitopathy Limit the Use of Radioiodine Therapy?
105
Does Transient Hypothyroidism following Therapy Influence the Course of Graves'
Orbitopathy?
107
Has Total Thyroid Ablation a Role in the Management of Hyperthyroidism in
Graves'Orbitopathy?
108
References
Contents
VIII
Ill Management of Mild Graves' Orbitopathy
Salvi,
M.;
Curro,
N.
(Milan)
111
What Is the Degree of Intra-Orbital Involvement in Mild Graves Orbitopathy?
111
Are Mild Forms of Graves Orbitopathy Likely to Progress to More Severe
Graves Orbitopathy
?
112
Is a 'Wait and See'Policy Justified in Mild Graves Orbitopathy?
114
Are Low-Dosage Oral Steroids Advisable or Is Orbital Irradiation Preferable?
115
Can We Reassure Patients About the
Long-Term
Safety of Orbital Irradiation?
11
б
What Is the Rationale for
Antioxidant
Therapy in GO?
117
References
120
Management of Moderately Severe Graves' Orbitopathy
Kahaly, G.J. (Mainz)
120
Is Immunosuppression Indicated in Moderately Severe Graves' Orbitopathy?
121
What Are the Results of Randomized Trials with Steroids?
131
What Are the Results of Randomized Trials Using Orbital Radiotherapy?
135
Do You Favor Combination Therapy?
138
What Are the Results of Randomized Trials Using Nonsteroid Immunosuppressants?
144
What Are the Results of Randomized Trials Using Somatostatin Analogs?
147
What Should You Do if Steroids Fail?
148
What Are the Actual Evidence-Based Therapeutic Recommendations for Patients with
Moderately Severe Graves' Orbitopathy?
149
Acknowledgments
149
References
153
Management of Very Severe Graves' Orbitopathy
(Dysthyroid Optic Neuropathy)
Lane, CM. (Cardiff);
Boschi,
A. (Brussels)
153
How Do You Define Dysthyroid Optic Neuropathy?
153
Are There Specific Risk Factors for Dysthyroid Optic Neuropathy?
154
Which Symptoms Should Alert Me?
155
What Are the Ophthalmological Signs of Dysthyroid Optic Neuropathy?
156
Are Additional Investigations Helpful?
156
How Fast Can Dysthyroid Optic Neuropathy Develop? Is Urgent Treatment Necessary?
157
What Is the Evidence Base for the Treatment of Dysthyroid Optic Neuropathy?
157
What Is the Role of Surgery in Dysthyroid Optic Neuropathy?
158
How Many Patients Become Blind due to Dysthyroid Optic Neuropathy?
158
References
160
Rehabilitative Surgery
Baldeschi, L. (Amsterdam)
160
Why Is This Chapter Called Rehabilitative Surgery and Not Cosmetic Surgery?
161
What Are the Steps and Timing of Rehabilitative Surgery?
161
How Should Patients Be Selected for Rehabilitative Surgery
162
References
Contents IX
163 Orbital
Decompression
Baldeschi,
L.
(Amsterdam)
163
What Is Orbital Decompression?
163
What Are the Aims of Orbital Decompression?
167
Which Surgical Technique Should Be Preferred?
172
What Are the Possible Complications of Orbital Decompression?
172
Can Complications Be Forecasted or Prevented?
173
References
176
Eye Muscle Surgery
Nardi,
M.
(Pisa)
176
What Is the Cause of Ocular Motility Impairment?
176
How Do You Identify the Affected Muscles?
178
How Can You Avoid Diagnostic Errors in Complex Cases?
179
How Can You Evaluate the Need for Surgery?
182
When Is the Right Time for Surgery?
182
What Can You Realistically Expect from Surgery?
182
How Should You Advise the Patient?
183
The Surgical Plan: What Procedures Are Recommended?
185
What Are the Possible Complications of Surgery and How Can I Avoid or Manage Them?
187
References
188
Eyelid Surgery
Neoh, C. (Newcastle upon Tyne); Eckstein, A. (Essen)
188
What Are the Indications for Eyelid Surgery in Patients with Graves'Orbitopathy?
189
Is Botulinum Toxin Useful?
190
Is Surgical Intervention Indicated in
Corneal
Ulcération
Secondary to Exposure
Keratopathy?
190
Does Orbital Decompression Have Any Effect on Lid Retraction?
191
Does Squint Surgery Influence the Lid Configuration?
193
What Surgical Procedures Are Available for Correction of Upper Lid Retraction?
195
Are There Complications?
196
What Surgical Procedures Are Available for Correction of Lower Lid Retraction?
196
Should This Be Combined with Horizontal Lid Tightening?
196
Which Materials Are Suitable for Use as Spacers? Should the Use of Allogeneic
Grafts Be Avoided?
197
Are There Complications?
198
What About Upper Lid Debulking and Upper and Lower Lid Blepharoplasty?
198
References
Miscellaneous Issues
201
Quality of Life
Wiersinga, W.M. (Amsterdam)
201
What Is Quality of Life?
201
What Is the Usefulness of Quality of Life Measurements?
Contents
χ
203
What Is Known about General Health-Related Quality of Life in Graves'Orbitopathy?
204
Is There a GO-Specific Quality of Life Questionnaire?
206
What Are the Results of the GO-QoL?
206
Can You Explain Response Shift in Quality of Life?
207
Can GO-QoL Be Used as a Separate Outcome Measurement in GO?
208
Is Quality of Life Fully Restored after Treatment of GO?
209
Can I Apply the GO-QoL in My Own Practice?
210
References
212
Atypical Manifestations
vonArx, G. (Olten)
212
What Are the Atypical Manifestations of Graves'Orbitopathy?
212
How Do You Explain Unilateral Graves' Orbitopathy (We Don't have
Graves'Hyperthyroidism in Just One Thyroid Lobe, Have We?)
216
Will Unilateral Graves' Orbitopathy Proceed to Bilateral Graves' Orbitopathy?
217
Is the Clinical Presentation of Unilateral Graves' Orbitopathy Different from Bilateral
Graves' Orbitopathy?
217
How Does Unilaterality Affect Treatment?
218
Is Euthyroid Graves'Orbitopathy a Reason to Refrain from Specific Eye Treatment?
219
What Is Globe
Subluxation?
219
References
221
Childhood Graves' Orbitopathy
Krassas, G.E.
(Thessaloniki)
221
Is Childhood Graves'Orbitopathy Really that Rare?
222
Is the Clinical Presentation of Graves'Orbitopathy in Childhood Different from that in
Adulthood?
222
Why Is Graves'Orbitopathy in Children Less Severe than in Adults?
224
What Is the Best Therapeutic Approach for Graves'Orbitopathy in Children and
Adolescents?
226
What About Surgical Decompression of the Orbit in Childhood?
226
References
229
Prevention
Bartalena, L.
(Várese)
229
What Is Primary, Secondary and Tertiary Prevention?
229
Can a General Strategy Be Applied to Prevent Graves'Orbitopathy?
230
What Can Be Done in the Primary Prevention of Graves'Orbitopathy?
231
What Can Be Done in Terms of Secondary Prevention of Graves' Orbitopathy?
233
What About Tertiary Prevention of Graves'Orbitopathy?
234
What Should One Do when Talking to a Graves' Orbitopathy Patient Who Smokes?
234
Acknowledgements
234
References
Contents XI
237
Future
Developments
Salvi,
M.
(Milan); Baldeschi,
L.
(Amsterdam)
237
Is There Evidence that Steroids in Graves'Orbitopathy Act as True
Immunosuppressants and Modify Disease Outcome?
238
What Are the Reasons for Exploring the Potential Efficacy of New
Immunosuppressive Medications?
238
Is There Evidence for the Efficacy of New Immunotherapy Agents in
Graves'Orbitopathy?
239
Which Anticytokine Treatment Would Be the Most Effective in Your Opinion?
239
What About Rituximab?
241
What About Interfering with the TSH Receptor Pathways?
241
Are Technical Developments in Surgical Approaches to Be Expected?
243
Are Conceptual Developments in Surgical Approaches to Be Expected?
243
References
246
Historical Notes on Graves' Disease
Mounts, M.P. (Amsterdam)
246
Is It Fair to Call Graves' Disease Graves'Disease?
247
Various Eye Signs Carry Specific Names: Are They Still Relevant?
248
How Did Old Theories Explain the Relationship between Hyperthyroidism and
Proptosis?
249
Which Are Rundle's Contributions to Our Understanding of Graves' Orbitopathy?
252
Which Are Kriss'Contributions to the Management of Graves' Orbitopathy?
252
When Was Evidence-Based Medicine Incorporated in Graves'Orbitopathy?
253
References
254
Author Index
255
Subject Index
Contents
XII |
| adam_txt |
Contents
XIII Preface
Wiersinga, W.M. (Amsterdam); Kahaly, G.J.
(Mainz)
Diagnosis and Pathogenesis
1
Clinical Manifestations
Dickinson, A.J. (Newcastle upon
Тупе)
1
What Are the Common Symptoms of Graves'Orbitopathy?
1
What Are the Common Signs of Graves 'Orbitopathy?
2
What Signs Are Unusual in Graves'Orbitopathy?
4
Are There Racial Differences in How Graves'Orbitopathy Manifests?
4
Is the Presentation of Graves'Orbitopathy Different in Older Compared to Younger
Patients?
5
Why Can the Clinical Presentation of Graves'Orbitopathy Be So Variable?
5
Can You Give Me a Short Mechanistic Explanation for All These Clinical
Manifestations?
6
What Do the Terms 'Activity' and 'Severity' Denote?
7
Why Is It Important to Distinguish Activity and Severity when Evaluating Patients?
8
What Symptoms and Signs Are Valuable for Assessing Activity?
8
How Are These Signs Assessed?
11
How Reproducible Are These Assessments?
11
What Value Does the 'Clinical Activity Score'Have?
12
Do Patients without Signs of Activity Ever Have Active Disease?
13
What Should I Do if I Am Not Sure whether the Disease Is Active?
13
Are There Any Other Ways to Evaluate Activity Other than Clinical Examination?
13
When Should These Other Methods for Assessing Activity Be Used in Routine
Clinical Practice?
14
What Signs Are Helpful for Assessing Severity?
14
What Value Does the Mnemonic 'NOSPECS'Have?
14
What Are the Relative Frequencies of Classes I-VI?
16
How Are Signs of Severity Assessed?
20
How Reproducible Are These Assessments?
20
How Do You Decide Whether a Patient Has Dysthyroid Optic Neuropathy?
22
Can Dysthyroid Optic Neuropathy Ever Be Present with Normal Vision?
22
Are Some Patients at Particular Risk?
22
What Other Assessments Are Useful in Evaluating Possible Dysthyroid Optic
Neuropathy?
23
Should These Tests Be Performed in All Patients at Every Assessment?
23
References
27
Orbit-Thyroid Relationship
Lazarus, J.H. (Cardiff); Marino, M. (Pisa)
27
Should This Condition Always Be Called Graves'Orbitopathy?
27
Does Graves Orbitopathy Occur in the Absence of Hyperthyroidism?
29
Do All Patients with Graves'Disease Have Graves Orbitopathy?
29
What Comes First in Graves'Disease? The Eye Changes or the Hyperthyroid Symptoms?
30
Do TSH Receptor Antibodies Also Cause GO?
31
Are There Any Other Extrathyroidal Manifestations of Graves'Disease Apart from
Graves
'
Orbitopathy?
32
References
34
Epidemiology
Daumerie, C. (Brussels); Kalmann, R. (Utrecht)
34
What Is the Present Estimated Prevalence of Graves' Orbitopathy? Has It Changed
over the Last Decade?
35
Is the Age and Sex Distribution of Graves'Orbitopathy Similar to that of Graves'
Disease?
35
Are There Ethnic Differences?
35
What Are the Risk Factors for the Occurrence of Graves' Orbitopathy?
36
Is Tobacco Bad for Graves' Orbitopathy?
37
Is Ocular Co-Morbidity Relevant for Graves'Orbitopathy?
37
Is Elevated Intraocular Pressure Relevant in Graves'Orbitopathy?
38
Is There Significant Non-Ocular Co-Morbidity (Like Diabetes) which Is Relevant
for Graves' Orbitopathy?
39
References
41
Pathogenesis
Orgiazzi, J.
(Lyon)
41
What Are the Pathological Changes in Orbital Tissue of Graves' Orbitopathy?
44
How Do the Pathological Changes Give Rise to the Clinical Manifestations?
45
What Triggers Graves'Orbitopathy?
46
Is Graves' Orbitopathy Triggered by an Autoimmune Phenomenon? If so, what Is the
Nature of the Auto-Antigen?
Contents VI
47
Why Is the Orbit a Special Target for Thyroid Autoimmunity?
48
What Kind of Immune Reaction Takes Place within the Orbit?
50
Do Anti-TSH Receptor Antibodies (TRAb) Play a Role in the Onset or Development
of Graves'Orbitopathy?
50
Is There a Familial Predisposition to Graves' Orbitopathy? Is There a Specific Genetic
Background for Graves' Orbitopathy?
51
Smoking Increases the Risk of Graves Orbitopathy and Its Severity: What Is the
Mechanism for It?
52
How May the Observations Described Above and the Current Understanding of the
Disease Lead to More Effective Treatment of Graves'Orbitopathy?
54
References
57
Orbital Imaging
Pitz, S. (Mainz)
57
Is Orbital Imaging Always Necessary?
57
What Are the Relative Benefits of Orbital CT and
MRI?
59
What Is Apical Crowding?
61
What Is the Place of Orbital Ultrasound?
62
What Lessons Can We Learn from Orbital Octreoscan?
62
What Other Imaging Techniques May Be Useful?
64
Acknowledgments
64
References
66
Diagnosis and Differential Diagnosis of Graves' Orbitopathy
Mounts, M.P. (Amsterdam)
66
Can You Give an Overall Scheme for the Diagnosis of Graves' Orbitopathy?
66
Which Clinical Findings Are Helpful in Making a Diagnosis of Graves'Orbitopathy?
70
Can One Make a Diagnosis of Graves'Orbitopathy Based on Medical History and
Clinical Picture Alone?
70
Do We Always Need to Order Thyroid Autoantibodies and Thyroid Function Tests?
71
Which Imaging Technique Is Best to Make a Diagnosis of Graves'Orbitopathy and Is
Imaging Always Requested?
72
Which Are the Most Frequent Conditions Mimicking Graves'Orbitopathy?
76
Conclusion
76
References
78
Natural History
Kendall-Taylor, P. (Newcastle upon Tyne)
78
Does Graves' Orbitopathy Occur at the Same Time as Hyperfhyroidism?
78
Does Restoring Euthyroidism Lead to Improvement in Graves'Orbitopathy?
79
What Effect May Hypothyroidism Have?
80
What Is the Typical Course of the Disease?
81
What Is the Difference between Activity and Severity?
83
How Do You Determine which Phase of the Disease the Patient Is Displaying? [see
also chapter by Dickinson, pp.
1—26]
Contents
VII
83
How Does the Phase of the Disease Influence Choice of Treatment?
84
Will the Graves'Orbitopathy Eventually Burn Itself Out?
84
Will the Orbital Changes Return to Normal when the Condition Eventually Resolves?
85
How Long Is it Likely to Take before the Disease Becomes Inactive?
85
Once the Condition Has Become Inactive (Whether Treated or Untreated) Is it Likely
to Flare Up Again?
85
Are There Any Other Factors, Additional to Thyroid Status, which May Influence the
Course of the Disease?
86
References
Management
88
General Management Plan
Boboridis, K.
(Thessaloniki);
Perros,
P. (Newcastle upon Tyne)
88
What Are the Priorities when Faced with a New Presentation of Graves'Orbitopathy?
89
How Good Is the Evidence that Quitting Smoking Helps?
89
Does Thyroid Status Affect the Eyes?
90
What Simple Measures Can Help the Eyes?
91
Is There a Place for Botulinum Toxin?
92
How Do You Define Mild, Moderately Severe, and Very Severe Graves'Orbitopathy?
92
Can You Give a Simplified Overall Management Scheme?
93
References
96
Combined Thyroid-Eye Clinics
Wiersinga, W.M. (Amsterdam)
96
What Are Combined Thyroid-Eye Clinics?
97
Why Is a Multidisciplinary Approach Recommended?
98
Can Patients-Support Groups Be Helpful?
98
I Have Heard of a Fast-Track Clinic for Graves' Orbitopathy Patients: What Is That?
99
References
100
Thyroid Treatment
Marcocci, C; Pinchera, A. (Pisa)
100
Does It Matter for the Eyes How the Patient Is Rendered Euthyroid?
103
Are There Any Specific Criteria to Prefer One of the Treatment Modalities for
Hyperthyroidism in Graves'Orbitopathy?
104
Is There Any Risk Factor which May Predict Worsening of Graves' Orbitopathy after
Radioiodine?
105
Should the Presence of Graves' Orbitopathy Limit the Use of Radioiodine Therapy?
105
Does Transient Hypothyroidism following Therapy Influence the Course of Graves'
Orbitopathy?
107
Has Total Thyroid Ablation a Role in the Management of Hyperthyroidism in
Graves'Orbitopathy?
108
References
Contents
VIII
Ill Management of Mild Graves' Orbitopathy
Salvi,
M.;
Curro,
N.
(Milan)
111
What Is the Degree of Intra-Orbital Involvement in Mild Graves Orbitopathy?
111
Are Mild Forms of Graves Orbitopathy Likely to Progress to More Severe
Graves Orbitopathy
?
112
Is a 'Wait and See'Policy Justified in Mild Graves Orbitopathy?
114
Are Low-Dosage Oral Steroids Advisable or Is Orbital Irradiation Preferable?
115
Can We Reassure Patients About the
Long-Term
Safety of Orbital Irradiation?
11
б
What Is the Rationale for
Antioxidant
Therapy in GO?
117
References
120
Management of Moderately Severe Graves' Orbitopathy
Kahaly, G.J. (Mainz)
120
Is Immunosuppression Indicated in Moderately Severe Graves' Orbitopathy?
121
What Are the Results of Randomized Trials with Steroids?
131
What Are the Results of Randomized Trials Using Orbital Radiotherapy?
135
Do You Favor Combination Therapy?
138
What Are the Results of Randomized Trials Using Nonsteroid Immunosuppressants?
144
What Are the Results of Randomized Trials Using Somatostatin Analogs?
147
What Should You Do if Steroids Fail?
148
What Are the Actual Evidence-Based Therapeutic Recommendations for Patients with
Moderately Severe Graves' Orbitopathy?
149
Acknowledgments
149
References
153
Management of Very Severe Graves' Orbitopathy
(Dysthyroid Optic Neuropathy)
Lane, CM. (Cardiff);
Boschi,
A. (Brussels)
153
How Do You Define Dysthyroid Optic Neuropathy?
153
Are There Specific Risk Factors for Dysthyroid Optic Neuropathy?
154
Which Symptoms Should Alert Me?
155
What Are the Ophthalmological Signs of Dysthyroid Optic Neuropathy?
156
Are Additional Investigations Helpful?
156
How Fast Can Dysthyroid Optic Neuropathy Develop? Is Urgent Treatment Necessary?
157
What Is the Evidence Base for the Treatment of Dysthyroid Optic Neuropathy?
157
What Is the Role of Surgery in Dysthyroid Optic Neuropathy?
158
How Many Patients Become Blind due to Dysthyroid Optic Neuropathy?
158
References
160
Rehabilitative Surgery
Baldeschi, L. (Amsterdam)
160
Why Is This Chapter Called Rehabilitative Surgery and Not Cosmetic Surgery?
161
What Are the Steps and Timing of Rehabilitative Surgery?
161
How Should Patients Be Selected for Rehabilitative Surgery
162
References
Contents IX
163 Orbital
Decompression
Baldeschi,
L.
(Amsterdam)
163
What Is Orbital Decompression?
163
What Are the Aims of Orbital Decompression?
167
Which Surgical Technique Should Be Preferred?
172
What Are the Possible Complications of Orbital Decompression?
172
Can Complications Be Forecasted or Prevented?
173
References
176
Eye Muscle Surgery
Nardi,
M.
(Pisa)
176
What Is the Cause of Ocular Motility Impairment?
176
How Do You Identify the Affected Muscles?
178
How Can You Avoid Diagnostic Errors in Complex Cases?
179
How Can You Evaluate the Need for Surgery?
182
When Is the Right Time for Surgery?
182
What Can You Realistically Expect from Surgery?
182
How Should You Advise the Patient?
183
The Surgical Plan: What Procedures Are Recommended?
185
What Are the Possible Complications of Surgery and How Can I Avoid or Manage Them?
187
References
188
Eyelid Surgery
Neoh, C. (Newcastle upon Tyne); Eckstein, A. (Essen)
188
What Are the Indications for Eyelid Surgery in Patients with Graves'Orbitopathy?
189
Is Botulinum Toxin Useful?
190
Is Surgical Intervention Indicated in
Corneal
Ulcération
Secondary to Exposure
Keratopathy?
190
Does Orbital Decompression Have Any Effect on Lid Retraction?
191
Does Squint Surgery Influence the Lid Configuration?
193
What Surgical Procedures Are Available for Correction of Upper Lid Retraction?
195
Are There Complications?
196
What Surgical Procedures Are Available for Correction of Lower Lid Retraction?
196
Should This Be Combined with Horizontal Lid Tightening?
196
Which Materials Are Suitable for Use as Spacers? Should the Use of Allogeneic
Grafts Be Avoided?
197
Are There Complications?
198
What About Upper Lid Debulking and Upper and Lower Lid Blepharoplasty?
198
References
Miscellaneous Issues
201
Quality of Life
Wiersinga, W.M. (Amsterdam)
201
What Is Quality of Life?
201
What Is the Usefulness of Quality of Life Measurements?
Contents
χ
203
What Is Known about General Health-Related Quality of Life in Graves'Orbitopathy?
204
Is There a GO-Specific Quality of Life Questionnaire?
206
What Are the Results of the GO-QoL?
206
Can You Explain Response Shift in Quality of Life?
207
Can GO-QoL Be Used as a Separate Outcome Measurement in GO?
208
Is Quality of Life Fully Restored after Treatment of GO?
209
Can I Apply the GO-QoL in My Own Practice?
210
References
212
Atypical Manifestations
vonArx, G. (Olten)
212
What Are the Atypical Manifestations of Graves'Orbitopathy?
212
How Do You Explain Unilateral Graves' Orbitopathy (We Don't have
Graves'Hyperthyroidism in Just One Thyroid Lobe, Have We?)
216
Will Unilateral Graves' Orbitopathy Proceed to Bilateral Graves' Orbitopathy?
217
Is the Clinical Presentation of Unilateral Graves' Orbitopathy Different from Bilateral
Graves' Orbitopathy?
217
How Does Unilaterality Affect Treatment?
218
Is Euthyroid Graves'Orbitopathy a Reason to Refrain from Specific Eye Treatment?
219
What Is Globe
Subluxation?
219
References
221
Childhood Graves' Orbitopathy
Krassas, G.E.
(Thessaloniki)
221
Is Childhood Graves'Orbitopathy Really that Rare?
222
Is the Clinical Presentation of Graves'Orbitopathy in Childhood Different from that in
Adulthood?
222
Why Is Graves'Orbitopathy in Children Less Severe than in Adults?
224
What Is the Best Therapeutic Approach for Graves'Orbitopathy in Children and
Adolescents?
226
What About Surgical Decompression of the Orbit in Childhood?
226
References
229
Prevention
Bartalena, L.
(Várese)
229
What Is Primary, Secondary and Tertiary Prevention?
229
Can a General Strategy Be Applied to Prevent Graves'Orbitopathy?
230
What Can Be Done in the Primary Prevention of Graves'Orbitopathy?
231
What Can Be Done in Terms of Secondary Prevention of Graves' Orbitopathy?
233
What About Tertiary Prevention of Graves'Orbitopathy?
234
What Should One Do when Talking to a Graves' Orbitopathy Patient Who Smokes?
234
Acknowledgements
234
References
Contents XI
237
Future
Developments
Salvi,
M.
(Milan); Baldeschi,
L.
(Amsterdam)
237
Is There Evidence that Steroids in Graves'Orbitopathy Act as True
Immunosuppressants and Modify Disease Outcome?
238
What Are the Reasons for Exploring the Potential Efficacy of New
Immunosuppressive Medications?
238
Is There Evidence for the Efficacy of New Immunotherapy Agents in
Graves'Orbitopathy?
239
Which Anticytokine Treatment Would Be the Most Effective in Your Opinion?
239
What About Rituximab?
241
What About Interfering with the TSH Receptor Pathways?
241
Are Technical Developments in Surgical Approaches to Be Expected?
243
Are Conceptual Developments in Surgical Approaches to Be Expected?
243
References
246
Historical Notes on Graves' Disease
Mounts, M.P. (Amsterdam)
246
Is It Fair to Call Graves' Disease Graves'Disease?
247
Various Eye Signs Carry Specific Names: Are They Still Relevant?
248
How Did Old Theories Explain the Relationship between Hyperthyroidism and
Proptosis?
249
Which Are Rundle's Contributions to Our Understanding of Graves' Orbitopathy?
252
Which Are Kriss'Contributions to the Management of Graves' Orbitopathy?
252
When Was Evidence-Based Medicine Incorporated in Graves'Orbitopathy?
253
References
254
Author Index
255
Subject Index
Contents
XII |
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| index_date | 2024-07-02T18:42:40Z |
| indexdate | 2024-07-20T09:24:04Z |
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| spelling | Graves' orbitopathy a multidisciplinary approach ; 38 tables eds.: Wilmar M. Wiersinga ... 1. Aufl. Basel [u.a.] Karger 2007 XIX, 260 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Endokrine Ophthalmopathie (DE-588)4196103-1 gnd rswk-swf Basedow-Augen-Symptom (DE-588)4219400-3 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Endokrine Ophthalmopathie (DE-588)4196103-1 s DE-604 Basedow-Augen-Symptom (DE-588)4219400-3 s b DE-604 Wiersinga, Wilmar M. Sonstige oth text/html http://deposit.dnb.de/cgi-bin/dokserv?id=2980657&prov=M&dok_var=1&dok_ext=htm Inhaltstext Digitalisierung UB Regensburg application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016033687&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Graves' orbitopathy a multidisciplinary approach ; 38 tables Endokrine Ophthalmopathie (DE-588)4196103-1 gnd Basedow-Augen-Symptom (DE-588)4219400-3 gnd |
| subject_GND | (DE-588)4196103-1 (DE-588)4219400-3 (DE-588)4143413-4 |
| title | Graves' orbitopathy a multidisciplinary approach ; 38 tables |
| title_auth | Graves' orbitopathy a multidisciplinary approach ; 38 tables |
| title_exact_search | Graves' orbitopathy a multidisciplinary approach ; 38 tables |
| title_exact_search_txtP | Graves' orbitopathy a multidisciplinary approach ; 38 tables |
| title_full | Graves' orbitopathy a multidisciplinary approach ; 38 tables eds.: Wilmar M. Wiersinga ... |
| title_fullStr | Graves' orbitopathy a multidisciplinary approach ; 38 tables eds.: Wilmar M. Wiersinga ... |
| title_full_unstemmed | Graves' orbitopathy a multidisciplinary approach ; 38 tables eds.: Wilmar M. Wiersinga ... |
| title_short | Graves' orbitopathy |
| title_sort | graves orbitopathy a multidisciplinary approach 38 tables |
| title_sub | a multidisciplinary approach ; 38 tables |
| topic | Endokrine Ophthalmopathie (DE-588)4196103-1 gnd Basedow-Augen-Symptom (DE-588)4219400-3 gnd |
| topic_facet | Endokrine Ophthalmopathie Basedow-Augen-Symptom Aufsatzsammlung |
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