Sight threatening in Graves' orbitopathy

Q; 32 year old female with Grave's disease and with a known orbitopathy (exophthalmos) is in ICU for the management of thyroid storm. Patient complains of  loss of color vision. You next step of management?

A) Continue to observe

B) Warm compression

C) Intravenous (IV) thyroxine bolus

D) IV dexamethasone 4 mg

E) Orbital decompression surgery

Answer: D

Visual impairment in Graves' orbitopathy is a medical as well as a surgical emergency. The most common initial complaint is loss of color vision. Ophthalmology should be called immediately for urgent orbital decompression. Meanwhile 4 mg IV dexamethasone should be given immediately as a first step.

#endocrinology

#opthalomplogy

References:

1. Tramunt B, Imbert P, Grunenwald S, Boutault F, Caron P. Sight-threatening Graves' orbitopathy: Twenty years' experience of a multidisciplinary thyroid-eye outpatient clinic. Clin Endocrinol (Oxf). 2019 Jan;90(1):208-213. doi: 10.1111/cen.13880. Epub 2018 Nov 19. PMID: 30339291.

2. Bartalena L. Sight-Threatening Graves’ Ophthalmopathy. [Updated 2019 Jan 3]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279098/