Bilateral 30mm proptosis, getting prepared for
orbital decompression.

Ocular involvement (ophthalmopathy) is not uncommon in patients with thyroid disease. In these patients, the thyroid status can be quite variable. Whilst the majority are hyperthyroid, some are hypothyroid and a few are euthyroid. Indeed in some cases it may be difficult to demonstrate any thyroid abnormality at all. Due to the complexity of the condition, the need for careful management of any underlying thyroid dysfunction, the potential threat to vision and the toxic side effects of many of the therapies, close cooperation between an ophthalmologist and an endocrinologist is required. Ideally both should have a special interest in thyroid eye disease and there is a strong case for seeing these patients in a joint clinic so that medical and surgical management can be carefully coordinated1.

A recent European survey by Weetman & Wiersinga2 showed considerable variation in practice with regard to the investigation and management of these cases. Thus it is not surprising that there is no consensus on when to use steroids, immuno suppressants, orbital radiotherapy, thyroid or ocular surgery. This makes it even more important for physician and surgeon to work closely together. We report our approach to the joint management to these cases.

1 Kendall-Taylor P. Current Management of Thyroid-Associated Ophthalmopahty. Clinical Endocrinology 1998. 49:11-12.

2 Weetman A & Wiersinga WMM. Current Management of Thyroid-Associated Ophthalmopathy in Europe. Results of an International Survey. Clinical Endocrinology 1998. 49: 21-28.

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