[et_pb_section fb_built=”1″ fullwidth=”on” admin_label=”T\u00edtulo” _builder_version=”4.19.5″ background_color=”#dcdcdc” background_image=”https:\/\/www.oftalmologiahigienopolis.com\/wp-content\/uploads\/2017\/08\/pattern-4.jpg” background_size=”contain” background_repeat=”repeat” custom_css_main_element=”height: 160px;” global_module=”649″ collapsed=”on” global_colors_info=”{}”][et_pb_fullwidth_post_title meta=”off” featured_image=”off” text_color=”light” admin_label=”T\u00edtulo” _builder_version=”4.16″ title_font=”||||||||” title_text_color=”#FFFFFF” title_font_size=”28px” title_letter_spacing=”2px” title_line_height=”1.4em” background_color=”#5a90bc” parallax=”on” text_orientation=”center” custom_margin=”0px||0px||true|false” custom_padding=”5px||10px||false|false” custom_padding_tablet=”0px||0px||true|false” custom_padding_last_edited=”off|desktop” title_font_size_tablet=”26px” title_font_size_phone=”” title_font_size_last_edited=”on|tablet” custom_css_main_element=”width: 100%; bottom: 0; position: absolute;” custom_css_post_title=”padding-bottom: 0 !important;” parallax_effect=”on” module_bg_color=”#5a90bc” border_style=”solid” saved_tabs=”all” global_colors_info=”{}”][\/et_pb_fullwidth_post_title][\/et_pb_section][et_pb_section fb_built=”1″ specialty=”on” admin_label=”Conte\u00fado” _builder_version=”4.19.5″ collapsed=”off” global_colors_info=”{}”][et_pb_column type=”3_4″ specialty_columns=”3″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_row_inner admin_label=”Introdu\u00e7\u00e3o” _builder_version=”4.19.5″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” global_colors_info=”{}”][et_pb_column_inner saved_specialty_column_type=”3_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.19.5″ text_font=”||||||||” text_font_size=”18px” text_line_height=”1.9em” header_font=”||||||||” header_2_font=”|700|||||||” header_2_text_color=”#34749A” header_2_font_size=”28px” custom_padding=”0px|0px|0px|0px” border_style=”solid” global_colors_info=”{}”]<\/p>\n
![\"Orbitopatia](\"https:\/\/www.oftalmologiahigienopolis.com\/wp-content\/uploads\/2017\/07\/oftalmopatia-de-graves.jpg\")
A Orbitopatia de Graves (OG) \u00e9 a manifesta\u00e7\u00e3o extratireoidiana de maior relev\u00e2ncia da Doen\u00e7a de Graves. A OG decorre de um processo auto-imune que acomete os m\u00fasculos extra-oculares, gordura e tecidos moles orbit\u00e1rios de formas heterog\u00eaneas resultando em um quadro cl\u00ednico bastante vari\u00e1vel.<\/p>\n
[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner _builder_version=”4.16″ _module_preset=”default” custom_padding=”||0px||false|false” global_colors_info=”{}”][et_pb_column_inner saved_specialty_column_type=”3_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_divider color=”#e9f0f7″ divider_weight=”5px” _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_divider][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner admin_label=”Causas e Fatores de Risco” module_class=”oh-content-box” _builder_version=”4.19.5″ collapsed=”off” global_colors_info=”{}”][et_pb_column_inner saved_specialty_column_type=”3_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text admin_label=”T\u00edtulo” module_class=”oh-content-box-title” _builder_version=”4.19.5″ _module_preset=”default” header_3_font=”||||||||” background_enable_color=”off” custom_margin=”||||false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n
[\/et_pb_text][et_pb_text module_class=”oh-content-box-text” _builder_version=”4.19.5″ _module_preset=”default” background_enable_color=”off” custom_margin=”||||false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n
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A Orbitopatia de Graves pode ocorrer em qualquer idade, mas apresenta dois picos de incid\u00eancia: 5\u00aa e 7\u00aa d\u00e9cadas de vida. Trata-se de uma doen\u00e7a mais comum em mulheres. Embora a Doen\u00e7a de Graves esteja muito associada ao hipertireoidismo, os pacientes com OG podem estar hipo ou eutireoideos. Fatores gen\u00e9ticos, ambientais e anat\u00f4micos est\u00e3o envolvidos no desenvolvimento da OG.<\/p>\n
O mecanismo da OG provavelmente decorre de processos imunes humoral e mediado por c\u00e9lulas desencadeado por auto ant\u00edgenos compartilhados com a tire\u00f3ide, como o receptor de TSH. O fibrobl\u00e1sto orbit\u00e1rio parece ter papel central no processo inflamat\u00f3rio orbit\u00e1rio tanto como alvo da imunidade como mediador da inflama\u00e7\u00e3o e expans\u00e3o tecidual. A heterog\u00eanea popula\u00e7\u00e3o de fibroblastos contida no tecido conectivo orbit\u00e1rio pode ser a causa das diferentes formas cl\u00ednicas da OG.<\/p>\n
[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner admin_label=”Sintomas” module_class=”oh-content-box” _builder_version=”4.19.5″ collapsed=”off” global_colors_info=”{}”][et_pb_column_inner saved_specialty_column_type=”3_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text admin_label=”T\u00edtulo” module_class=”oh-content-box-title” _builder_version=”4.19.5″ _module_preset=”default” header_3_font=”||||||||” background_enable_color=”off” custom_margin=”||||false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n
[\/et_pb_text][et_pb_text module_class=”oh-content-box-text” _builder_version=”4.19.5″ _module_preset=”default” background_enable_color=”off” custom_margin=”||||false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n
Clinicamente, o espectro dessas combina\u00e7\u00f5es se manifesta pelos dois polos cl\u00ednicos da orbitopatia: o miog\u00eanico e o lipog\u00eanico. No primeiro tipo (miog\u00eanico) o aumento dos m\u00fasculos extraoculares \u00e9 o fator principal na g\u00eanese do quadro cl\u00ednico de proptose e estrabismo restritivo. No segundo tipo (lipog\u00eanico) o aumento dos m\u00fasculos extraoculares \u00e9 discreto e o quadro cl\u00ednico de exoftalmo sem restri\u00e7\u00e3o da motilidade ocular decorre principalmente do aumento do volume da gordura orbit\u00e1ria.<\/p>\n S\u00e3o dois os est\u00e1gios da doen\u00e7a<\/strong>: existe uma fase ativa que dura entre 6 a 24 meses, onde o processo inflamat\u00f3rio est\u00e1 presente e as altera\u00e7\u00f5es orbit\u00e1rias evoluem; a fase sequelar compreende um quadro cl\u00ednico est\u00e1vel referente \u00e0s sequelas da fase ativa.<\/p>\n A doen\u00e7a tamb\u00e9m pode ser dividida em leve, moderada e grave.<\/p>\n [\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner admin_label=”Diagn\u00f3stico” module_class=”oh-content-box” _builder_version=”4.19.5″ collapsed=”off” global_colors_info=”{}”][et_pb_column_inner saved_specialty_column_type=”3_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text admin_label=”T\u00edtulo” module_class=”oh-content-box-title” _builder_version=”4.19.5″ _module_preset=”default” header_3_font=”||||||||” background_enable_color=”off” custom_margin=”||||false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n [\/et_pb_text][et_pb_text module_class=”oh-content-box-text” _builder_version=”4.19.5″ _module_preset=”default” background_enable_color=”off” custom_margin=”||||false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n S\u00e3o solicitados exames laboratoriais de fun\u00e7\u00e3o tireoidiana: TSH, T4 livre, T3, imunidade tireoidiana: anticorpo antitireoperoxidase (anti-TPO), anticorpo antitireoglobulina (anti-Tg), anticorpo antireceptores de TSH (TRAb) e TC \u00f3rbita para avaliar espessamentos da musculatura extr\u00ednseca e aumento da gordura orbit\u00e1ria (\u00fatil tamb\u00e9m para defini\u00e7\u00e3o do polo cl\u00ednico), al\u00e9m dos m\u00fasculos mais afetados: RI > RM > RS\/Elevador da p\u00e1lpebra, importante para avaliar compress\u00e3o do nervo \u00f3ptico no \u00e1pice orbit\u00e1rio (sinal de alerta para neuropatia \u00f3ptica compressiva).<\/p>\n [\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner admin_label=”Tratamento” module_class=”oh-content-box” _builder_version=”4.19.5″ collapsed=”off” global_colors_info=”{}”][et_pb_column_inner saved_specialty_column_type=”3_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text admin_label=”T\u00edtulo” module_class=”oh-content-box-title” _builder_version=”4.19.5″ _module_preset=”default” header_3_font=”||||||||” background_enable_color=”off” custom_margin=”||||false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n [\/et_pb_text][et_pb_text module_class=”oh-content-box-text” _builder_version=”4.19.5″ _module_preset=”default” background_enable_color=”off” custom_margin=”||||false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n [\/et_pb_text][et_pb_text admin_label=”Fase Ativa” module_class=”oh-content-box-text” _builder_version=”4.19.5″ _module_preset=”default” background_enable_color=”off” custom_margin=”||||false|false” custom_padding=”||||false|false” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n [\/et_pb_text][et_pb_text admin_label=”Radioterapia” module_class=”oh-content-box-text” _builder_version=”4.19.5″ _module_preset=”default” background_enable_color=”off” custom_margin=”||||false|false” custom_padding=”||||false|false” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n [\/et_pb_text][et_pb_text admin_label=”Fase Sequelar” module_class=”oh-content-box-text” _builder_version=”4.19.5″ _module_preset=”default” background_enable_color=”off” custom_margin=”||||false|false” custom_padding=”||||false|false” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n [\/et_pb_text][et_pb_text admin_label=”Medidas gerais” module_class=”oh-content-box-text” _builder_version=”4.19.5″ _module_preset=”default” background_enable_color=”off” custom_margin=”||||false|false” custom_padding=”||||false|false” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n![\"\"](\"https:\/\/www.oftalmologiahigienopolis.com\/wp-content\/uploads\/2017\/08\/icon-sintomas.jpg\"){kind=icon}
Os principais sinais cl\u00ednicos da OG s\u00e3o retra\u00e7\u00e3o palpebral<\/a><\/strong>, exoftalmo, estrabismo restritivo, quemose, les\u00f5es da superf\u00edcie ocular, edema e eritema palpebral, aumento da press\u00e3o intra-ocular e congest\u00e3o orbit\u00e1ria. Em torno de 5% dos pacientes, o aumento dos m\u00fasculos pode levar \u00e0 neuropatia \u00f3ptica compressiva.<\/p>\nDiagn\u00f3stico da Orbitopatia de Graves<\/h3>\n
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O diagn\u00f3stico \u00e9 baseado na observa\u00e7\u00e3o da retra\u00e7\u00e3o palpebral<\/a><\/strong> superior associado a um dos seguintes achados: fun\u00e7\u00e3o ou imunidade tire\u00f3idea alterada, proptose, estrabismo restritivo ou neuropatia compressiva.<\/p>\nTratamento da Orbitopatia de Graves<\/h3>\n
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O tratamento depender\u00e1 do diagn\u00f3stico da fase da doen\u00e7a e sua gravidade, que pode estar na fase ativa, na radioterapia ou na fase sequelar.<\/p>\nFase Ativa:<\/strong><\/h4>\n
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Radioterapia:<\/strong><\/h4>\n
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Fase Sequelar:<\/strong><\/h4>\n
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*Medidas gerais para o tratamento do paciente com Orbitopatia de Graves:<\/strong><\/h4>\n