Review Question - QID 100410

Though beta-blockers such as propanolol/metropolol and PTU are beneficial in preventing thyrotoxicosis, they do not treat exophthalmos. Corticosteroids can be used to help alleviate exophthalmos.

Exophthalmos occurs due to lymphocytic infiltration in the retro-orbital region and not due to beta-adrenergic over-stimulation. It is believed that cells in the retro-orbital region express TSH receptors leading to T-cell infiltration and an autoimmune response. Corticosteroids may be used in the treatment of exophthalmos in order to control the underlying inflammation.

Reid et al. review the diagnosis and treatment of hyperthyroidism reporting that the most common cause of hyperthyroidism is Graves' disease. Other common causes of hyperthyroidism include thyroiditis, toxic multinodular goiter, toxic adenomas, and medication side effects. The diagnostic workup begins with measuring the thyroid-stimulating hormone (TSH) level.

Maheshwari et al. explain that exophthalmos in Graves' disease results from a complex interplay of orbital fibroblast, cytokines, immune cells, autoantibodies, environmental and genetic factors. Of note, exophthalmos does not improve with thyroid-suppressing drugs and mainly requires glucocorticoids for treatment.

Illustration A shows a patient with exophthalmos. Note the forward protrusion of the globe from the orbit.

Incorrect Answers:
Answers 1 and 2: Beta-blockers are effective in reducing thyrotoxicosis, however they do not help in reducing exophthalmos
Answer 3: PTU helps reduce the amount of thyroid hormone produced, however does not help to reduce exophthalmos
Answer 5: This will not resolve spontaneously and requires treatment