Distiroidna orbitopatija i terapijska primjena botulinum toksina

master's thesis

• Title (english): Dysthyroid orbitopathy and therapeutic use of botulinum toxin
• Author: Daša Kerman
• Mentor: Jelena Juri Mandić (mentor)
• Committee member: Tomislav Jukić (predsjednik povjerenstva)
• Committee member: Miro Kalauz (član povjerenstva)
• Committee member: Jelena Juri Mandić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Ophthalmology and Optometry); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Ophthalmology

Abstract

Distiroidna orbitopatija ili Gravesova orbitopatija (GO) autoimuni je poremećaj obično udružen s Gravesovom bolešću, a nastaje zbog uvećanja orbitalnih mišića i masnog tkiva kao posljedica edema i odlaganja glikozaminoglikana i kolagena. Češće se javlja u žena, a učestalost je 16 žena i 3 muškarca na 100 000 ljudi. Pušenje je čimbenik rizika koji je najjače vezan uz pojavu i progresiju orbitopatije, a dovodi i do smanjenog učinka terapije. 25-50% osoba ima kliničke manifestacije GO. Najčešće su prisutni: retrakcija vjeđa, proptoza i tegobe zbog okularne ekspozicije. U aktivnoj fazi bolesti mogu se razviti ozbiljnije manifestacije poput crvenila i edema periokularnog mekog tkiva, restriktivne miopatije i diplopije, a ponekad i distiroidna optička neuropatija. Pojavljuje se u 5-7% slučajeva i očituje se gubitkom vidne oštrine i poremećajem raspoznavanja boja. EUGOGO je multidisiplinarno udruženje kliničara koji su razvili kriterije za evaluaciju pacijenata s GO. Na temelju tih kriterija određuje se tko će se i kako liječiti ovisno o aktivnosti i težini bolesti. Postoje različite terapijske mogućnosti ovisno o težini bolesti koja može biti blaga, umjerena do teška ili vidno ugrožavajuća i tad zahtijeva hitnu intervenciju. Botulinum toksin je egzotoksin koji stvara gram pozitivna bakterija Clostridium botulinum. Tehnološki pripravak botulinum toksina A koristi se za liječenje različitih medicinskih stanja. Glavne indikacije za korištenje u pacijenata s GO su retrakcija vjeđa i strabizam u akutnoj fazi bolesti. Mehanizam djelovanja je indukcija reverzibilne kemodenervacije s prolaznim učinkom koji obično traje nekoliko tjedana ili mjeseci. Operacija je indicirana tek ako je bolest stabilna barem 6-12 mjeseci.

Abstract (english)

Dysthyroid orbitopathy or Graves’ orbitopathy (GO) is an autoimmune disorder usually associated with Graves’ disease. It occurs due to orbital muscle and fat tissue enlargement because of edema and deferment of glycosaminoglycans and collagen. It is more common in women and incidence is 16 women and 3 men out of 100 000 people. Smoking is the risk factor associated with orbitopathy appearance and progression and it leads to decreased therapy success. 25-50% of people have clinical manifestations of GO. Eyelid retraction, proptosis and difficulties due to ocular exposition are most often present. In an active phase of the disease there can be present more serious manifestations such as periocular soft tissue redness and edema, restrictive myopathy and diplopia, sometimes even dysthyroid optic neuropathy. It occurs in 5-7% of cases and manifests with the visual acuity loss and color recognition disorder. EUGOGO is a multidisciplinary association of clinicians who developed criteria for evaluation of GO patients. Based on these criteria it is decided who and how will be treated considering disease activity and severity. There are various treatment options depending on the severity of the disease which can be mild, moderate to severe or sight threatening that requires immediate attention. Botulinum toxin is an exotoxin produced by a gram positive bacteria Clostridium botulinum. Technological composition of botulinum toxin type A is used for treating various medical conditions. Main indications in patients with GO are eyelid retraction and strabismus in the acute phase of the disease. Mechanism of action is induction of reversible chemodenervation with transient effect lasting usually a couple of weeks or months. Operation is indicated when the disease is stable for at least 6-12 months.

• Keywords: distiroidna orbitopatija; Gravesova orbitopatija; retrakcija vjeđa; proptoza; botulinum toksin A
• Keywords (english): Dysthyroid orbitopathy; Graves’ orbitopathy; eyelid retraction; proptosis; botulinum toxin A
• Language: croatian
• URN:NBN: urn:nbn:hr:105:729265
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-12-06 11:31:44