Zdeněk Fryšák, David Karásek, Milan Halenka, Jan Schovánek
Endocrine orbitopathy (EO) is increasingly considered as a systemic disease. Percentage of patients suffering from EO
is rather small, however the high frequency of thyroid disease in population, makes their total number not negligible.
Consequences of inadequate treatment are irreversible appearance changes and impairment of visual functions. Clinical
and laboratory diagnosis has been profoundly described, reflecting the regularly updated best clinical practice guidelines.
Despite all, there remain several questions to be elucidated, for example the causing factor of EO, several are
suspected and generally the oxidative stress is underlying theme. We can evaluate a panel of thyroid specific tests, including
possibility of quantifying specific stimulating immunoglobulins (TSI), which could discriminate most of the cases.
But from time to time some patients seek the care in endocrinologists, ophthalmologists or neurologists without
any overt evidence of thyroid disease and otherwise, though completely clinically negative they are proved to have
eye muscles changes. Separate and quite typical entity of a very malicious variant of EO is known as „dysthyroid optic
neuropathy”(DON), which could lead to blindness. Inadequate or delayed treatment, as well as the noncompliant
patient significantly affects the therapy effect. Although the diagnostic and therapeutic algorithms are processed into
details, it is evident that in some particular cases the main problem remains setting of correct diagnosis in appropriate
time. The following lines based on our own experience should alert the reader about the possible mistakes and ways
how to avoid them.