Keeping an Eye on Graves' Ophthalmopathy: Case Series

Graves' orbitopathy (GO) is the most common extrathyroidal manifestation of Graves' disease (GD) and manifests itself in symptoms and signs of involvement of the orbits and neighboring tissues. Approximately 15% of patients with GD who do not present clinical signs of GO at the onset of the disease will develop it in the first 3 to 6 months. TSH receptors are also expressed in several extrathyroidal tissues, especially in the retroorbital tissues. For this reason, complaints such as strabismus, diplopia, proptosis (exophthalmos) and eyelid retraction are common in this ophthalmopathy. Its incidence is higher in women, as it is an autoimmune disease, but it is still considered relatively rare, with 5-6% of cases classified as moderate to severe. Therefore, as it is a less frequent condition, this case series aims to report the diagnosis and management of Graves' orbitopathies in two male patients with moderate activity of severe disease in a large endocrinology service. By considering and expanding the dissemination around this diagnosis, it may be possible to improve the prognosis of these patients, preventing fibrosis and sequelae such as changes in appearance, proptosis and dysfunction of the extrinsic ocular muscles. The objective of this study is to highlight possible errors in the diagnosis and treatment of Graves' disease and ophthalmopathy that may lead to future consequences.