Diabetes mellitus: a risk factor in patients with Graves' orbitopathy

Abstract

Aims-To assess the prevalence of dysthyroid optic neuropathy (DON) in patients with diabetes mellitus (DM) and Graves' orbitopathy (GO) and to investigate the complications of surgery for GO in these patients. Methods-The records of 482 consecutive patients with GO referred in a 5 year period were studied. Those patients who also had DM were selected for further study. The prevalence of insulin dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM) was registered, as well as the prevalence and course of DON. In the patients who underwent surgery for GO the postoperative complications were recorded. Results-Out of 482 patients with GO, 15 (3.1%) also had DM. Eight (1.7%) had IDDM, 7 (1.4%) had NIDDM. Five patients (33.3%) three with IDDM and two with NIDDM developed DON with 50% improvement of visual acuity after treatment, whereas in the whole population of 482 GO patients 19 had DON (3.9%), showing 69.4% improvement of vision after treatment. 10 patients with GO and DM were operated for GO; in one of them an optic atrophy developed as a result of a postoperative haemorrhage directly after a three wall orbital decompression by coronal approach. No other postoperative complications occurred. Conclusions-The prevalence of IDDM in patients with GO is higher than in the normal population. DON occurs much more frequently in patients with GO and DM than in the total group of GO patients and seems to have a worse visual prognosis. (Br J Ophthalmol 1999;83:463-465) Graves' orbitopathy (GO) is a disorder of presumed autoimmune nature, closely related to Graves' thyroid disease.1 It is the most frequent orbital disorder in adults. Clinical findings typically consist of eyelid swelling, lid retraction, proptosis, acquired double vision, and impaired visual acuity. Blindness resulting from optic neuropathy, is the most threatening complication.2 Dysthyroid optic neuropathy (DON) is generally accepted as being caused by compression of enlarged extraocular muscles at the orbital apex; vasculopathy associated with smoking and diabetes may be an additional factor. [3][4][5] Diabetes mellitus (DM) is the most common endocrine disorder, with a significant morbidity and mortality. 6 The most prevalent form of DM is non-insulin dependent diabetes mellitus (NIDDM) which is caused by a combination of genetic and environmental factors resulting in insulin deficiency and insulin resistance. 7 8 Autoimmunity is supposed to be the major aetiological factor in insulin dependent diabetes mellitus (IDDM). 9 The major long term complication of DM is a generalised vasculopathy with basement membrane disease, blood flow disorders, and platelet abnormalities as the three basic mechanisms of vascular injury. 10In a previous study we found that the combination of DON and DM was associated with a worse response to orbital decompression.11 Therefore, we retrospectively studied those patients in whom the two disorders coexisted. The aims of this study were to assess the prevalence and course of DON in patie...

Hyperthyroidism in 276 Children and Adolescents with Type 1 Diabetes from Germany and Austria

“…GD prevalence in Italian children with T1DM is 0.53%, and thus as high as in the general population [3]. In the Netherlands, T1DM appears to be more frequent in patients with GD than in the general population (1.7 vs. 0.22-0.26%) [5]. The combination of T1DM and GD may be part of type 2 or type 3 polyglandular autoimmune syndrome [6,7].…”

Sekundäre Diabetesformen

“…Besonders schwierig ist die Therapie von Menschen mit Diabetes, M. Basedow und behandlungsbedürftiger endokriner Orbitopathie [10]. Sowohl die für die Therapie der endokrinen Orbitopathie einzusetzenden Steroide als auch eine Retrobulbärbestrahlung gefährden Diabetespatienten in besonderem Maße.…”

Epidemiology

“…Several studies show a higher incidence of DON (15-35%) in GO patients with DM compared to GO patients without DM (3-4%) [29,30]. The higher incidence of DON in patients with GO and DM could be explained by a marginal oxygenation of the optic nerve in diabetic patients, due to the vasculopathy; this makes the optic nerve more suitable to pressure of the enlarged extraocular muscles.…”

“…In one study, 33% of the diabetics developed DON with 50% improvement in visual acuity after treatment, whereas in the whole population of 482 GO patients, 19 had DON (3.9%) showing 69.4% improvement of vision after treatment [29].…”

“…The prevalence of type 1 diabetes mellitus (DM) or insulin-dependent diabetes mellitus is higher in patients with GO than in the normal population. In a Dutch study, of 482 patients with GO, 3.1% also had diabetes mellitus: 8 (1.7%) had type 1 diabetes, and 7 (1.4%) had type 2 diabetes [29].…”