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Thyroid associated ophthalmopathy continues to vex endocrinologists, ophthalmologists, and immunologists. At one of the earliest meetings of the Thyroid Club (now the British Thyroid Association) the debate on this subject was so intense that the secretary urged that it continue until no one was left, and the meeting closed with some difficulty at 10.00pm. Forty years later controversy still rages about the pathogenesis, the relation to the thyroid condition, and the best way to treat both the orbit and the thyroid in these patients.
This book, remarkably, is written by a single author and encompasses all of these areas. Devron Char is professor of ophthalmology and radiation oncology at the University of California at San Francisco. As the book is in its third edition already within 10 years, this demonstrates the changes that have been made in our understanding and provides a continuously revised text which gives a vast array of information. The shortcoming of this approach is that it is very difficult for anyone to be an expert these days in all areas that touch on ophthalmopathy. It is particularly in the areas of arcane immunology that the book is perhaps weakest and in future editions it might be worth commandeering the services of an immunologist to write specifically on this topic even if this leads to loss of uniform style. Another difficulty is that the text, although divided into sections, might benefit from further breakdown under subheadings. This is particularly apparent in chapter 6 which covers the pathogenesis and pathophysiology of thyroid ophthalmopathy. All of the immunological studies are grouped together under a single heading with no subdivision into genetics, antibodies, T cell involvement, and so on and this makes a difficult subject for the non-specialist even more taxing. There also appears to be some confusion over the role of free T4 testing in chapter 3 (Systemic diagnostic tests for thyroid ophthalmopathy and euthyroid ophthalmopathy). Free T4 assays are now simple, reliable, and cheap.
These, however, are relatively minor drawbacks compared with the overall worth of the book. The layout is very good and the pictures are excellent. The references are generally up to date as far as 1995 and there are one or two from 1996. Moreover, the references are extensive and give a detailed overview of even the earliest history of work on this disease. The second half of the book which details management is superb giving an overview of medical management (including radiation therapy) and surgical approaches. The author shows what can go wrong as well as what can go right and the personal account given makes compelling reading. Anyone who deals with thyroid associated ophthalmopathy will learn from this book. Perhaps by the next, or next but one, edition some of the questions which still remain will have been answered.
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