eMedicine Specialties > Ophthalmology > Orbit

Thyroid Ophthalmopathy: Follow-up

Author: Edsel Ing, MD, FRCSC, Assistant Professor, Department of Ophthalmology & Vision Sciences, University of Toronto: Consulting Staff, Toronto East General Hospital
Contributor Information and Disclosures

Updated: Apr 30, 2008

Follow-up

Further Outpatient Care

  • Patients should receive follow-up care as needed.

Complications

  • With thyroid exophthalmos, corneal exposure can occur.

Prognosis

  • Prognosis is generally favorable for patients with this condition. Most patients do not require surgical intervention.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • TAO can be asymmetric.
  • Optic nerve compression in TAO can occur in the absence of obvious proptosis.  For this reason, always check for retropulsion. 
  • TAO should not be mistaken for a dural arteriovenous malformation or a carotid cavernous fistula.
  • Early diagnosis and appropriate monitoring of TAO may decrease corneal exposure and compressive optic neuropathy.
  • In patients with TAO who have proptosis and inferior scleral show, simple horizontal tightening of the lower lid will result in increased globe exposure.
  • Prior to bony orbital decompression, a CT scan should be obtained because it delineates bony anatomy better than an MRI.

Special Concerns

  • Pregnancy and TAO  
    • The incidence of hyperthyroidism in women who are pregnant has been reported to be approximately 0.2%. Information on the management of TAO during pregnancy is not widely available.
    • The author is not aware of literature that supports caesarean delivery over vaginal delivery in women with TAO who are pregnant. If a pregnant woman with TAO has compressive optic neuropathy, steroids can usually be administered in consultation with the obstetrician and an endocrinologist. Ideally, surgery should be deferred until after delivery when possible. However, if emergent orbital decompression is required, nonabdominal surgery may not impose the same risks to the fetus as that of abdominal surgery.
  • Childhood TAO  
    • In general, children with TAO tend to have a more benign disease course, with less ophthalmoplegia, than adults. In comparison with adults, surgical intervention is infrequently required with children. 
    • Children and their parents should be counseled to avoid smoking. Secondhand smoke seems to exacerbate autoimmune thyroid disease, and passive smoking may have a deleterious effect on childhood TAO.
 


More on Thyroid Ophthalmopathy

Overview: Thyroid Ophthalmopathy
Differential Diagnoses & Workup: Thyroid Ophthalmopathy
Treatment & Medication: Thyroid Ophthalmopathy
Follow-up: Thyroid Ophthalmopathy
Multimedia: Thyroid Ophthalmopathy
References
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Further Reading

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Keywords

Graves ophthalmopathy, Graves' ophthalmopathy, thyroid-associated ophthalmopathy, TAO, thyroid-related eye disease, von Basedow ophthalmopathy, von Basedow's ophthalmopathy

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Contributor Information and Disclosures

Author

Edsel Ing, MD, FRCSC, Assistant Professor, Department of Ophthalmology & Vision Sciences, University of Toronto: Consulting Staff, Toronto East General Hospital
Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American College of Physician Executives, American Society of Contemporary Ophthalmology, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, North American Neuro-Ophthalmology Society, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Jorge G Camara, MD, Chairman, Department of Ophthalmology and Otorhinolaryngology, Director of Fellowship Training Program, St Francis Medical Center; Associate Professor, Department of Surgery, University of Hawaii School of Medicine
Jorge G Camara, MD is a member of the following medical societies: American Academy of Ophthalmology and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal, and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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