We present a long-term follow-up examination concerning patients with isolated extra-ocular muscle involvement in thyroid-related orbitopathy. Within the previous 13 years we observed 7 patients with endocrine orbitopathy and marked myopathy of the extra-ocular muscles. Five of these patients had no detectable proptosis, 2 of them showed a minimal unilateral proptosis. Five patients showed elevated thyroid-stimulating hormone (TSH) receptor auto-antibodies and 6 patients a marked swelling of the extra-ocular eye muscles on CT or MRI scans. One patient had elevated antibodies against thyroid peroxidase and against thyroglobulin and normal TSH receptor auto-antibodies. Four of 7 patients underwent clinical and radiological follow-up examination 1–9 years later. In 3 of these 4 patients, the clinical syndrome had completely resolved. None of the patients had developed any proptosis. The swelling of the eye muscles on radiological imaging had at least partially resolved. We conclude from our results that apart from the frequent subtype of endocrine orbitopathy with predominant proptosis there is a separate subtype in which proptosis neither exists initially nor develops in the further course. Probably these subtypes have a specific immunological antibody profile although they do not differ concerning the thyroid-stimulating antibodies.

Keywords:
Endocrine orbitopathy, Proptosis, Extra-ocular eye muscle dysfunction, Thyroid-stimulating antibodies, Vertical diplopia
1.
Heufelder AE, Spitzweg C: Pathogenese der immunogenen Hyperthyreose und endokrinen Orbitopathie. Internist 1998;39:599–606.
2.
Fung S, Malhotra R: Thyroid orbitopathy. Aust Fam Physician 2003;32:615–620.
3.
Goh SY, Ho SC: Thyroid autoantibody profiles in ophthalmic dominant and thyroid dominant Graves’ disease differ and suggest ophthalmopathy is a multiantigenic disease. Clin Endocrinol 2004;60:600–607.
4.
Förster G, Kahaly G: Endokrine Orbitopathie. Med Klin 1998;93:365–373.
5.
Weetman AP: Graves’ disease. N Engl J Med 2000;343:1236–1248.
6.
Prummel MF, Bakker A: Multi-center study on the characteristics and treatment strategies of patients with Graves’ orbitopathy: the first European Group on Graves’ Orbitopathy experience. Eur J Endocrinol 2003;148:491–495.
7.
Patrinely JR, Osborn AG: Computed tomographic features of nonthyroid extraocular muscle enlargement. Ophthalmology 1990;97:4–5.
8.
Villadolid MC, Yokoyama N: Untreated Graves’ disease patients without clinical ophthalmopathy demonstrate a high frequency of extraocular muscle (EOM) enlargement by magnetic resonance. J Clin Endocrinol Metab 1995;80:2830–2833.
9.
Berkhoff M, Sturzenegger M: Okuläre Myositis. Nervenarzt 1997;68:792–800.
10.
Shambal S, Lindner A: Successful treatment of orbital myositis with intravenous immunoglobulins. Muscle Nerve 1998;21:1359–1360.
11.
Simon GJ, Syed HM: Extraocular muscle enlargement with tendon involvement in thyroid-associated orbitopathy. Am J Ophthalmol 2004;137:1145–1147.
12.
Yu Wai Man CY, Chinnery PF: Extraocular muscles have fundamentally distinct properties that make them selectively vulnerable to certain disorders. Neuromuscular Disord 2004;15:17–23.
13.
Kloprogge SJ, Busuttil BE: TSH receptor protein is selectively expressed in normal human extraocular muscle. Muscle Nerve 2005;32:95–98.
14.
Mizokami T, Salvi M: Eye muscle antibodies in Graves’ ophthalmopathy: pathogenic or secondary epiphenomenon? J Endocrinol Invest 2004;27:221–229.
© 2008 S. Karger AG, Basel
2008
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.