Graves diseases with severe progressive ophthalmopathy after thyroidectomy. Case report.

Abstract

Graves’ disease is an autoimmune disease that may consist of hyperthyroidism, goiter, orbitopathy, and occasionally a dermopathy referred to as pretibial or localized myxedema. Graves’ disease is caused by autoantibodies that bind to the thyrotropin receptor, stimulating growth of the thyroid and overproduction of thyroid hormone. Clinical manifestations of Graves’ disease include diffuse goiter and symptoms and signs resulting from hyperthyroidism. Thyroid hormones excess affects several different body systems, and for this reason, signs and symptoms associated with Graves’ disease can vary strongly, and significantly influence the general well-being. Common symptoms are: tremor, heat sensitivity and warm, weight loss even if with normal eating habits, anxiety and irritability, enlargement of the thyroid gland, alterations in menstrual cycles, erectile dysfunction or decreased libido, fatigue, frequent bowel movements, palpitations, and others. Graves’ orbitopathy is present in about 30-50% of patients with Graves disease. Graves’ orbitopathy is an autoimmune disease of the retroocular tissues occurring in patients with Graves’ disease.We present the clinical case report with progressive ophthalmopathy after a total thyroidectomy. In our case after surgery his ophthalmopathy did not regress and, in fact, was progressive. In the vast majority of cases of Grave’s ophthalmopathy, the periorbital edema regresses significantly after a total thyroidectomy. This patient’s ophthalmopathy did not regress after surgery even the ophtalmopathy progressed. Only after initiation of pulsatile therapy of 500 mg of methylprednisolone weekly did the ophthalmopathy regress noticeably.