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Contents
ОглавлениеPreface to the Third, Revised and Expanded Edition
Wiersinga, W.M. (Amsterdam); Kahaly, G.J. (Mainz)
Preface to the Second, Revised Edition
Wiersinga, W.M. (Amsterdam); Kahaly, G.J. (Mainz)
Wiersinga, W.M. (Amsterdam); Kahaly, G.J. (Mainz)
Dickinson, A.J. (Newcastle upon Tyne); Hintschich, C. (Munich)
What Are the Common Signs and Symptoms of Early Graves’ Orbitopathy?
What Are Other Signs and Symptoms of Graves’ Orbitopathy?
What Signs Should Question the Diagnosis of Graves’ Orbitopathy?
Are There Racial Differences in How Graves’ Orbitopathy Manifests?
Is the Presentation of Graves’ Orbitopathy Different in Older Compared to Younger Patients?
Why Can the Clinical Presentation of Graves’ Orbitopathy Be So Variable?
Can You Give Me a Short Mechanistic Explanation for All These Clinical Manifestations?
What Do the Terms “Activity” and “Severity” Denote?
Why Is It Important to Distinguish Activity and Severity when Evaluating Patients?
What Signs and Symptoms Are Valuable for Assessing Activity?
How Reproducible Are These Assessments?
What Value Does the “Clinical Activity Score” Have?
Do Patients without Signs of Activity Ever Have Active Disease?
What Should I Do if I Am Not Sure whether the Disease Is Active?
Are There Any Other Ways to Evaluate Activity other than Clinical Examination?
When Should These Other Methods for Assessing Activity Be Used in Routine Clinical Practice?
What Signs Are Helpful for Assessing Severity?
What Value Does the Mnemonic “NOSPECS” Have?
How Are Signs of Severity Assessed?
How Reproducible Are These Assessments?
How Is Severity Best Classified?
How Do You Decide whether a Patient Has Dysthyroid Optic Neuropathy?
Can Dysthyroid Optic Neuropathy Ever Be Present with Normal Vision?
Are Some Patients at Particular Risk?
What Other Assessments Are Useful in Evaluating Possible Dysthyroid Optic Neuropathy?
Should These Tests Be Performed in All Patients at Every Assessment?
Are There Any Other Assessment Systems in Common Use?
Marinò, M. (Pisa)
Should This Condition Always Be Called Graves’ Orbitopathy?
Is Graves’ Orbitopathy Exclusively Occurring in Patients with Graves’ Hyperthyroidism?
Do All Patients with Graves’ Hyperthyroidism Have Graves’ Orbitopathy?
Are There Any Relationships between Hyperthyroidism, Hypothyroidism, and Graves’ Orbitopathy?
Is Graves’ Orbitopathy Related to Thyroid Autoimmunity?
Are There Other Extrathyroidal Manifestations of Graves’ Disease apart from Graves’ Orbitopathy?
Burlacu, M.-C.; Daumerie, C. (Brussels)
What Is the Estimated Incidence and Prevalence of Graves’ Orbitopathy?
Has the Occurrence of Graves’ Orbitopathy Changed over the Last Few Decades?
Is the Age and Sex Distribution of Graves’ Orbitopathy Similar to That of Graves’ Hyperthyroidism?
What Are the Risk Factors for the Occurrence of Graves’ Orbitopathy?
Can Particular Drugs Trigger or Modify Graves’ Orbitopathy and Its Course?
Is Tobacco Bad for Graves’ Orbitopathy?
Has Nutrition an Effect on Graves’ Orbitopathy?
Salvi, M. (Milan); Berchner-Pfannschmidt, U. (Essen); Ludgate, M. (Cardiff)
What Are the Pathological Changes in Orbital Tissue in Graves’ Orbitopathy?
How Do the Pathological Changes Give Rise to the Clinical Manifestations?
What Triggers Graves’ Orbitopathy?
Why Is the Orbit Special and a Target for Thyroid Autoimmunity?
What Kind of Immune Reactions Take Place within the Orbit?
Is There a Familial Predisposition or a Specific Genetic Background for Graves’ Orbitopathy?
How Do Environmental Factors Increase the Risk and Severity of Graves’ Orbitopathy?
Pitz, S.; Müller-Forell, W. (Mainz)
Is Orbital Imaging Always Necessary?
What Are the Relative Benefits of Orbital CT and MRI?
What Is the Place of Orbital Ultrasound?
What Lessons Can We Learn from Orbital Octreoscan?
What Other Imaging Techniques May Be Useful?
Diagnosis and Differential Diagnosis of Graves’ Orbitopathy
Konuk, O. (Ankara); Anagnostis, P. (Thessaloniki)
Can You Give an Overall Scheme for the Diagnosis of Graves’ Orbitopathy?
Which Clinical Findings Are Helpful in Making a Diagnosis of Graves’ Orbitopathy?
Can One Make a Diagnosis of Graves’ Orbitopathy Based on Medical History and Clinical Picture Alone?
Do We Always Need to Order Thyroid Autoantibody and Thyroid Function Tests?
Which Are the Most Frequent Conditions Mimicking Graves’ Orbitopathy?
Mamoojee, Y.; Pearce, S.H.S. (Newcastle upon Tyne)
Does Graves’ Orbitopathy Occur at the Same Time as Hyperthyroidism?
Does Restoring Euthyroidism Lead to Improvement in Graves’ Orbitopathy?
What Effect May Hypothyroidism Have?
What Is the Typical Course of the Disease?
What Happens to Orbital Fat during the Course of the Disease?
What Is the Difference between Activity and Severity?
How Do You Determine Which Phase of the Disease the Patient Is Displaying?
How Does the Phase of the Disease Influence the Choice of Treatment?
Will Graves’ Orbitopathy Eventually Burn Itself Out?
Will the Orbital Changes Return to Normal when the Condition Eventually Resolves?
How Long Is It Likely to Take before the Disease Becomes Inactive?
Management
General Management Plan for Graves’ Orbitopathy
Bartalena, L. (Varese)
Is There General Agreement among Specialists on How to Manage Graves’ Orbitopathy?
What Are the Priorities when Faced with a New Presentation of Graves’ Orbitopathy?
Should the Patient Be Informed about Risk Factors Affecting the Course of Graves’ Orbitopathy?
What Is the Evidence about the Role of Smoking on the Course of Graves’ Orbitopathy?
Does Thyroid Status Affect Graves’ Orbitopathy?
Are There Simple Measures That Can Help the Eyes?
Is Early Referral to Specialized Centres Important?
Can You Provide the Patient with an Overall Management Scheme?
Törüner, F.B.; Konuk, O.; Ayvaz, G. (Ankara)
What Are Combined Thyroid-Eye Clinics?
Why Is a Multidisciplinary Approach Recommended?
Can Patient Support Groups Be Helpful?
I Have Heard of a Fast-Track Clinic for Graves’ Orbitopathy Patients: What Is That?
What Can I Expect when Starting a Combined Thyroid-Eye Clinic?
Hegedüs, L.; Brix, T.H. (Odense)
Do the Eyes Care How Euthyroidism Is Obtained and Maintained?
Should the Presence of Graves’ Orbitopathy Restrict Our Use of Radioiodine Therapy?
Management of Mild Graves’ Orbitopathy
Marcocci, C.; Rocchi, R. (Pisa)
Are Mild Forms Likely to Progress to More Severe Graves’ Orbitopathy?
Is a “Wait-and-See” Policy Justified in Patients with Mild Graves’ Orbitopathy?
Are Low-Dosage Oral Steroids Advisable or Is Orbital Radiotherapy Preferable?
What Is the Rationale for Antioxidant Therapy like Selenium in Graves’ Orbitopathy?
Management of Moderately Severe Graves’ Orbitopathy
Kahaly, G.J. (Mainz)
How Is Moderately Severe Graves’ Orbitopathy Defined?
Is Immunosuppression Indicated in Moderately Severe Graves’ Orbitopathy?
What Are the Cellular and Molecular Mechanisms of Steroid Anti-Inflammation and Immunosuppression?
What Are the Results of Randomized Trials with Steroids?
What Are the Results of Randomized Trials Using Orbital Radiotherapy?
Do You Favour Combined Steroid/Radiotherapy?
What Are the Results of Randomized Trials Using Non-Steroid Immunosuppressants?
What Are the Results of Randomized Trials Using Somatostatin Analogues?
How Should a Diabetic or Hypertensive Patient with Moderately Severe Graves’ Orbitopathy Be Treated?
What Should You Do if Steroids Fail?
What Do the ETA/EUGOGO Guidelines for the Management of Graves’ Orbitopathy Recommend?
Novel Immunomodulatory Treatment Modalities
Lane, L.C.; Perros, P.; Pearce, S.H.S. (Newcastle upon Tyne)
Why Look for New Immunomodulatory Treatments?
What Are the Targets for Potential Novel Therapies?
What Are the Most Likely Targets for Therapeutic Intervention?
Should Clinicians Be Cautious about Trying Novel Immunomodulators?
Management of Very Severe Graves’ Orbitopathy: Dysthyroid Optic Neuropathy and Corneal Breakdown
Boschi, A. (Brussels); Currò, N. (Milan)
How Do You Define Dysthyroid Optic Neuropathy? What Is the Causative Mechanism?
Are There Specific Risk Factors for Dysthyroid Optic Neuropathy?
Which Symptoms Should Alert Me for Dysthyroid Optic Neuropathy?
What Are the Ophthalmological Signs of Dysthyroid Optic Neuropathy?
Are Additional Investigations Helpful?
How Fast Can Dysthyroid Optic Neuropathy Progress? Is Urgent Treatment Necessary?
What Is the Evidence Base for the Treatment of Dysthyroid Optic Neuropathy?
What Is the Role of Surgery in Dysthyroid Optic Neuropathy?
How Many Patients Become Blind due to Dysthyroid Optic Neuropathy?
How Can I Recognize Corneal Breakdown?
What Is the Recommended Treatment of Corneal Breakdown?
Boboridis, K.; Anagnostis, P. (Thessaloniki)
Is Graves’ Orbitopathy Related to Ocular Surface Pathology?
When and How Should We Support the Ocular Surface?
Can Local Measures Address Eyelid Retraction?
Can Local Measures Reduce Orbital Inflammation in Graves’ Orbitopathy?
Can Local Measures Improve the Visual Disturbance and Diplopia?
Baldeschi, L. (Brussels)
Why Is This Chapter Called Rehabilitative Surgery and Not Cosmetic Surgery?
What Are the Steps and Timing of Rehabilitative Surgery?
How Should Patients Be Selected for Rehabilitative Surgery?
Baldeschi, L. (Brussels); Morris, D.S. (Cardiff)
What Is Orbital Decompression?
What Are the Aims of Orbital Decompression?
What Are the Different Types of Orbital Decompression?
What Are the Possible Complications of Orbital Decompression?
Can Complications Be Predicted or Prevented?
Nardi, M. (Pisa); Eckstein, A. (Essen)
What Are the Reasons for Impairment of Ocular Motility in Graves’ Orbitopathy?
How Does Decompression Influence Ocular Motility?
How Do You Identify the Affected Muscles?
How Can You Avoid Diagnostic Errors in Complex Cases?
What Is the Optimal Pretreatment before You Start Eye Muscle Surgery?
When Is the Right Time for Surgery?
How Do You Deal with Diplopia until Surgery Is Possible?
How Can You Evaluate the Need for Surgery?
The Surgical Plan: What Procedures Are Recommended?
What Are the Possible Complications of Surgery and How Can I Avoid or Manage Them?
What Can You Realistically Expect from Surgery?
How Can Success of Surgery Be Measured?
How Should You Advise the Patient?
Clarke, L. (Newcastle upon Tyne); Eckstein, A. (Essen)
What Are the Indications for Eyelid Surgery in Patients with Graves’ Orbitopathy?
Is Surgical Intervention Indicated in Corneal Ulceration Secondary to Exposure Keratopathy?
Does Orbital Decompression Have Any Effect on Lid Retraction?
Does Squint Surgery Influence the Lid Configuration?
Can Decompression Be Combined with Lid Lengthening?
What Surgical Procedures Are Available for Correction of Upper Lid Retraction?
What Surgical Procedures Are Available for Correction of Lower Lid Retraction?
Should This Be Combined with Horizontal Lid Tightening?
Which Materials Are Suitable for Use as Spacers? Should the Use of Allogeneic Grafts Be Avoided?
What about Upper Lid Debulking and Upper and Lower Lid Blepharoplasty?
Does Lid Surgery Improve the Quality of Life of the Patients?
How Can the Effect of Lid Surgery Be Quantified?
Miscellaneous Issues
Wiersinga, W.M. (Amsterdam)
What Is the Usefulness of Quality of Life Measurements?
What Is Known about General Health-Related Quality of Life in Graves’ Orbitopathy?
Is There a Graves’ Orbitopathy-Specific Quality of Life Questionnaire?
What Are the Results of the GO-QoL?
Can You Explain Response Shift in Quality of Life?
Can GO-QoL Be Used as a Separate Outcome Measurement in Graves’ Orbitopathy?
What Is the Experience with GO-QoL as Outcome Measurement in the Literature?
Are There Other Disease-Specific Quality of Life Questionnaires for Graves’ Orbitopathy?
Are There Qualitative Studies on Quality of Life in Graves’ Orbitopathy?
Is Quality of Life Fully Restored after Treatment of Graves’ Orbitopathy?
What Can I Conclude and Should I Apply the GO-QoL in My Own Practice?
Kahaly, G.J. (Mainz)
Is There an Actual Cost Estimation of Thyroid Disorders in Germany and/or Europe?
Does Graves’ Orbitopathy Lead to Occupational Disability?
What Are the Findings of the Performed Prospective Study?
What Are the Relevant Implications for the Daily Clinical Practice?
Do We Have Data on the Public Health Relevance of Graves’ Orbitopathy?
von Arx, G. (Olten); Ayvaz, G. (Ankara)
Will the Treatment for the Thyroid Make the Eyes Better or Worse?
Can Graves’ Orbitopathy Be Prevented?
Will My Eyes Always Get Worse?
What Can Be Done about Common Eye Symptoms of Graves’ Orbitopathy?
Will the Eyes Go Back to Normal?
Are There Any Risk Factors for a Progressive and Severe Graves’ Orbitopathy?
Can I Contact Patient Support Groups or Fellow Patients?
If Graves’ Orbitopathy Is an Autoimmune Disease, Does That Mean My Immune System Is Collapsed?
After Orbital Radiation, When Will It Be Possible to Have a Baby?
Daumerie, C. (Brussels); Fichter, N. (Olten)
What Are the Atypical Manifestations of Graves’ Orbitopathy?
What Are Other Diseases Mimicking Unilateral or Atypical Graves’ Orbitopathy?
What Is the Prevalence of Unilateral Graves’ Orbitopathy?
Can We Predict the Course of Unilateral Graves’ Orbitopathy?
What Is Euthyroid/Hypothyroid Graves’ Orbitopathy?
How Will You Manage Euthyroid/Hypothyroid Graves’ Orbitopathy?
Bartalena, L. (Varese)
How Frequent Is Graves’ Orbitopathy in Children?
Are Signs and Symptoms of Graves’ Orbitopathy in Childhood Similar to Those in Adulthood?
Why Is Graves’ Orbitopathy in Children and Adolescents Milder than in Adults?
What Medical Treatment for Graves’ Orbitopathy in Children and Adolescents?
What Modality of Treatment for Hyperthyroidism in Children/Adolescents with Graves’ Orbitopathy?
What about Orbital Decompression in Childhood?
Comorbidity in Graves’ Orbitopathy
Žarković, M., Knežević, M. (Belgrade)
What Is the Risk of Diabetes Mellitus in Graves’ Orbitopathy?
What Is the Risk of Osteoporosis in Graves’ Orbitopathy?
What Is the Risk of Mental Disorders in Graves’ Orbitopathy?
What Is the Risk of Dry Eye Syndrome in Graves’ Orbitopathy?
What Is the Risk of Glaucoma in Graves’ Orbitopathy?
What Is the Risk of Cataract in Graves’ Orbitopathy?
What Is the Risk of Retinopathy in Graves’ Orbitopathy?
Marcocci, C.; Marinò, M. (Pisa)
What Is Primary, Secondary, and Tertiary Prevention?
What Variables Can Be Modified in the Prevention of Graves’ Orbitopathy?
What Can Be Done in Primary and Secondary Prevention of Graves’ Orbitopathy?
What Can Be Done in Tertiary Prevention of Graves’ Orbitopathy?
What Should One Do when Talking to a Graves’ Orbitopathy Patient Who Smokes?
Protocols of Non-Surgical Therapies
Bartalena, L. (Varese)
What Is the Protocol for Selenium?
What Is the Protocol for Intravenous Glucocorticoids?
What Is the Protocol for Oral Glucocorticoids?
What Is the Protocol for Orbital Radiotherapy?
What Is the Protocol for Cyclosporine?
What Is the Protocol for Rituximab?
The Amsterdam Declaration on Graves’ Orbitopathy
Perros, P. (Newcastle upon Tyne)
What Is the Amsterdam Declaration?
Appendix 1: The Amsterdam Declaration
Appendix 2: Signatories of the Amsterdam Declaration
Historical Notes on Graves’ Disease
Perros, P. (Newcastle upon Tyne)
What Is the Earliest Recorded Case of Graves’ Disease and Graves’ Orbitopathy?
What Were the Early Theories about Graves’ Disease and Graves’ Orbitopathy?
What Lessons Should Be Learnt from the History of Graves’ Disease and Graves’ Orbitopathy?
