Erdei Annamaria, Gazdag Annamaria, Ujhelyi Bernadett, Nagy Edit B, Berenyi Ervin, Berta Eszter, Steiber Zita, Barna Sandor, Mezosi Emese, Bodor Miklos, Nagy Endre V
Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Eur Thyroid J. 2022 Aug 11;11(5). doi: 10.1530/ETJ-22-0078. Print 2022 Oct 1.
Dysthyroid optic neuropathy (DON) is a rare, severe form of thyroid eye disease, in which decreased visual acuity is accompanied by characteristic MRI findings. The treatment of DON has always been a challenge.
In a patient in whom visual acuity deteriorated on the left eye, mannitol 20% 200 mL followed by furosemide 40 mg 6 h later, administered daily, were initiated on the day of admission. Visual function by ophthalmology methods, and orbital compartment volumes and water content by MRI were followed. Intravenous diuretics resulted in an immediate therapeutic response. Visual acuity improved from 20/50 to 20/25 after 2 days of treatment. MRI revealed decreasing water content of both the muscle and connective tissue compartments without any volume changes. Subsequently, corticosteroids and orbital irradiation were started. Orbital decompression surgery was not required.
DISCUSSION/CONCLUSION: Edematous swelling of orbital tissues is an established contributor of local pressure increase in thyroid eye disease. Diuretics reduce orbital pressure and, if confirmed by others, may be useful additions to the standard of care in sight-threatening DON.
甲状腺功能异常性视神经病变（DON）是一种罕见的、严重的甲状腺眼病形式，其中视力下降伴有特征性的MRI表现。DON的治疗一直是一项挑战。
一名左眼视力恶化的患者，入院当天开始每天静脉滴注20%甘露醇200 mL，6小时后静脉注射呋塞米40 mg。通过眼科方法监测视觉功能，并通过MRI监测眼眶腔容积和含水量。静脉利尿剂产生了即时治疗反应。治疗2天后，视力从20/50提高到20/25。MRI显示肌肉和结缔组织腔含水量减少，容积无变化。随后开始使用皮质类固醇和眼眶照射。无需进行眼眶减压手术。
讨论/结论：眼眶组织的水肿肿胀是甲状腺眼病局部压力升高的既定因素。利尿剂可降低眼眶压力，如果得到其他人的证实，可能会成为威胁视力的DON标准治疗的有益补充。
