Abstract 18: Clinical and demographic profile of thyroid-associated orbitopathy from a tertiary care centre in Kerala

Background: Graves orbitopathy also referred to as thyroid-associated orbitopathy (TAO) is the extrathyroidal manifestation of Graves' disease and the most common cause of exophthalmos. It is an immune disorder causing inflammation and expansion of orbital fat and muscle. It is seen in 25–50% of patients with Graves' disease and hyperthyroidism. Though common in our population, only limited data were available on the demographic profile and clinical features of thyroid orbitopathy. This study is planned to fill the knowledge gap in this area from our region Aim: To describe the demographic, clinical, and therapeutic outcome of Thyroid associated ophthalmopathy in patients with proven thyroid-associated orbitopathy Methods: We carried out a retrospective and descriptive analysis of 30 patients with TAO. This study was conducted in the Endocrinology department of GMC Thiruvananthapuram, between January 2020 and October 2022. A total of 30 patients enrolled during the period who met the inclusion criteria were studied. A well-structured proforma was used to collect the data. All patients were subjected to detailed clinical evaluation and laboratory investigations. Results: 30 patients were included in the study. The mean age of patients was 48.7 ± 11.37 years. Female to male ratio was 1.6. 93.4% of the study population were non-smokers. 100% of patients had hyperthyroidism at presentation Orbitopathy was bilateral in all the patients. The most common ocular symptoms were prominent eyes (100% of patients), Proptosis, and upper eyelid retraction present in 100% of patients. Dysthyroid optic neuropathy and corneal ulceration were reported in one case. 16 of patients had Clinical Activity Score (CAS) 33/7. Sight-threatening orbitopathy was present in 3 patients.16 patients with CAS 3 3/7 were treated with Methylprednisolone pulse therapy (Total 12 doses- 4.5 g). 13 patients showed a significant improvement in signs and symptoms of orbital inflammation. 2 patients with refractory orbitopathy were given Rituximab infusion. Improvement in CAS scores was seen in both patients. One patient underwent Orbital radiation and decompression surgery Conclusion: TAO is a complex disease, which is associated with impaired quality of life and can potentially result in sight-threatening complications. This study conducted in GMC Thiruvanathapuram, a major endocrinology center in Kerala revealed that proptosis and upper eyelid retraction were the most common clinical feature associated with TAO. TAO can lead to significant visual impairment, as noticed among three patients in our study. 81.2% of patients with CAS) 33/7 responded well to Methylprednisolone pulse therapy. Refractory Orbitopathy patients showed clinical improvement with the initiation of Rituximab therapy. Appropriate early diagnosis, convenient therapy, and regular follow-up are necessary to improve results and avoid the aesthetic and functional complications of TAO.