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Case Reports
. 2019 Jan 17:9:810.
doi: 10.3389/fendo.2018.00810. eCollection 2018.

Active Moderate-to-Severe Graves' Orbitopathy in a Patient With Type 2 Diabetes Mellitus and Vascular Complications

Francesca Urselli  1 , Gilda Pontieri  1 , Livia Peschi  1 , Alessia Liccardi  1 , Anna Rita Ruggiero  1 , Bernadette Biondi  1
Affiliations
Case Reports

Active Moderate-to-Severe Graves' Orbitopathy in a Patient With Type 2 Diabetes Mellitus and Vascular Complications

Francesca Urselli et al. Front Endocrinol (Lausanne). .

Abstract

Background: Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease (GD). Diabetes mellitus (DM) has been reported to be a risk factor in patients with GO. Moreover, GO can be more frequent and severe in type 2 diabetes patients. High doses of intravenous glucocorticoids represent the first line treatment of moderate-to-severe and active GO according to the international guidelines. However, this therapy is contraindicated in uncontrolled diabetes and in patients with increased cardiovascular risk. Some anti-diabetic drugs can exacerbate GO. We reported the clinical case of an active and moderate-to-severe GO in a patient with uncontrolled type 2 DM and vascular complications. Case Report: A 61-years-old patient came to our ambulatory for a recurrence of GD and a moderate-to-severe bilateral GO. The patient had uncontrolled type 2 DM during insulin therapy and a history of micro and macrovascular complications. At the physical examination, the clinical activity score was 5 and the severity of GO was moderate-to-severe. A blood sample showed overt hyperthyroidism and the persistence of anti-TSH receptor antibodies (TRAb) during treatment with methimazole. A computed tomography scan showed a moderate-to-severe bilateral exophthalmos. We discuss the benefit/risk of treatment of GO in our patient. Conclusion: The available guidelines do not focus on the treatment of diabetic patients with uncontrolled diabetes and severe vascular complications, therefore our patient represents a difficult therapeutic challenge. The screening of thyroid function and the evaluation of GO could be useful in diabetic patients with autoimmune thyroid disease to perform a correct treatment of these disorders.

Keywords: Graves' orbitopathy; diabetes mellitus; glucocorticoids; hyperthyroidism; methotrexate; radiotherapy; tocilizumab.

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Figure 1
Clinical features of Graves' orbitopathy in our patient.
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References

    1. Bartalena L, Baldeschi L, Boboridis K, Eckstein A, Kahaly GJ, Marcocci C, et al. . The 2016 European Thyroid Association/European Group on graves' orbitopathy guidelines for the management of graves' orbitopathy. Eur Thyroid J. (2016) 5:9–26. 10.1159/000443828 - DOI - PMC - PubMed
    1. Bahn RS. Graves' ophthalmopathy. N Engl J Med. (2010) 362:726–38. 10.1056/NEJMra0905750 - DOI - PMC - PubMed
    1. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. . 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid (2016) 26:1343–421. 10.1089/thy.2016.0229 - DOI - PubMed
    1. Kalmann R, Mouritz MP. Diabetes mellitus: a risk factor in patients with Graves' orbitopathy. Br J Opthalmol. (1999) 83:463–5. - PMC - PubMed
    1. Hansen MP, Matheis N, Kahaly GJ. Type 1 diabetes and polyglandular autoimmune syndrome: a review. World J Diabetes (2015) 6:67–79. 10.4239/wjd.v6.i1.67 - DOI - PMC - PubMed

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