Asymmetry indicates more severe and active disease in Graves’ orbitopathy: results from a prospective cross-sectional multicentre study

Perros, Petros; Žarković, Miloš; Panagiotou, Grigorios; Azzolini, Claudio; Ayvaz, Göksün; Bartalena, Luigi; Boschi, Antonella; Nardi, Marco; Brix, Thomas Heiberg; Covelli, Danila; Daumerie, Chantal; Eckstein, Anja; Fichter, Nicole; Ćirić, Slavica; Kahaly, George J.; Konuk, Onur; Lareida, Jürg; Okosieme, Onyebuchi; Leo, Marenza; Mathiopoulou, Lemonia; Clarke, Lucy; Menconi, Francesca; Morris, Daniel S.; Orgiazzi, Jacques; Pitz, Susanne; Salvi, Mario; Muller, Ilaria; Knežević, Miloš; Wiersinga, Wilmar M.; Currò, Nicola; Dayan, Colin; Marcocci, Claudio; Marinò, Michele; Möller, Lars; Pearce, Simon H. S.; Törüner, Füsun Baloş; Bernard, Martine

doi:10.1007/s40618-020-01258-w

Cited by 24 publications

(28 citation statements)

References 26 publications

(43 reference statements)

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“…However, some patients might exhibit asymmetric or unilateral symptoms, for yet unknown reasons. It has been suggested that unilateral GO may progress to bilateral disease ( 11 ) and we have also found that asymmetry was associated with more severe and active GO ( 12 ). Asymmetry and/or unilateral GO can impose diagnostic challenges ( 13 ) and it is therefore important that awareness for asymmetric GO be raised.…”

Section: Introductionsupporting

confidence: 64%

“…In our recently published study, asymmetry was defined as bilateral disease with one or more of the following features: difference between the two eyes in exophthalmos by ≥2 mm; difference in palpebral aperture by ≥2 mm; difference in eyelid swelling by ≥1 grades; difference in eyelid erythema by ≥1 grades; difference in conjunctival redness by ≥1 grades; presence of dysthyroid optic neuropathy in one eye only. Unilateral disease was defined as one or more clinical features of GO in one eye without any evidence of GO in the contralateral eye ( 12 ). Moreover, disease severity is assessed similarly to bilateral disease, using clinically evaluated standardized tools, such as CAS ( 27 ) and Vision, Inflammation, Strabismus, Appearance (VISA) ( 28 ).…”

Section: Assessment Of Asymmetric And/or Unilateral Gomentioning

confidence: 99%

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Asymmetric Graves’ Orbitopathy

Panagiotou

Perros

2020

Front. Endocrinol.

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Graves’ Orbitopathy (GO) is an autoimmune orbital disorder usually presenting as a sequala of autoimmune thyroid disease. The presence of GO is associated with increased psychological burden and, in severe cases may cause blindness. While most patients with GO present with bilateral disease, asymmetric or unilateral GO may affect a significant proportion of patients diagnosed with GO. Older age, male sex, active and severe disease correlate with asymmetric disease. However, the exact mechanisms causing asymmetry remain elusive. Herein, we review the literature on asymmetric GO and highlight its differences compared with bilateral GO.

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Section: Introductionsupporting

confidence: 64%

Section: Assessment Of Asymmetric And/or Unilateral Gomentioning

confidence: 99%

Asymmetric Graves’ Orbitopathy

Panagiotou

Perros

2020

Front. Endocrinol.

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“…Asymmetric forms have been described in 4-14% of cases, unilateral forms in 9-34% of cases (9,(32)(33)(34). In a recent multicenter study of 269 patients referred to EUGOGO centers, although the majority (157 patients, 58%) had symmetric GO, many patients had either asymmetric or unilateral GO (26) (Figure 3). Interestingly, patients in the asymmetric group were older, were more frequently men, and tended to have more severe and active GO than the other groups (26).…”

Section: Phenotypementioning

confidence: 99%

“…In a recent multicenter study of 269 patients referred to EUGOGO centers, although the majority (157 patients, 58%) had symmetric GO, many patients had either asymmetric or unilateral GO (26) (Figure 3). Interestingly, patients in the asymmetric group were older, were more frequently men, and tended to have more severe and active GO than the other groups (26). The reasons for asymmetric presentation of GO are unknown, but they might include differences in the anatomy of bony orbit or its vascularization.…”

Section: Phenotypementioning

confidence: 99%

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Epidemiology, Natural History, Risk Factors, and Prevention of Graves’ Orbitopathy

et al. 2020

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GO is the most frequent extrathyroidal manifestation of Graves’ disease, although it may rarely occur in euthyroid/hypothyroid patients with chronic autoimmune thyroiditis. It is a relatively infrequent disorder, and men tend to have more severe ocular involvement at an older age. The prevalence of GO is lower than in the past among patients with recent onset Graves’ hyperthyroidism, and moderate-to-severe forms requiring aggressive treatments are no more than 5–6% of all cases of GO. After an initial inflammatory (active) phase and a phase of stabilization (plateau phase), GO tends to improve and eventually inactivates (inactive or burnt-out phase). Minimal-to-mild GO often remits spontaneously, but complete restitutio ad integrum almost never occurs when GO is more than mild. Several risk factors contribute to its development on a yet undefined genetic background. Cigarette smoking is the most important of them. Early diagnosis, control and removal of modifiable risk factors, early treatment of mild forms of GO may effectively limit the risk of progression to more severe forms, which have a profound and dramatic impact on the quality of life of affected individuals, and remain a therapeutic challenge, often requiring long-lasting and multiple medical and surgical therapies.

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Application of Multiparameter Quantitative Magnetic Resonance Imaging in the Evaluation of Graves' Ophthalmopathy

Luo

Feng

et al. 2023

Magnetic Resonance Imaging

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BackgroundAssessment of the activity of Graves' ophthalmopathy (GO) is difficult. Existing methods need improvement.PurposeInvestigate the application of multiparametric magnetic resonance imaging (MRI) in GO.Study TypeRetrospective.PopulationA total of 235 GO patients (age: 38.8 ± 13.4 years; 90 male; 96 active patients).Field Strength/SequenceShort‐tau inversion recovery (STIR) fast spin echo, multiecho spin echo T2 mapping and 3D T1‐weighted fast field echo sequences at 3.0 T.AssessmentTwo physicians assessed the mean and maximum signal intensity ratio of extraocular muscles to white matter (SIR), T2 relaxation time (T2RT), extraocular muscle area (EMA), fat fraction (FF), retrobulbar fat volume (RFV), and extraocular muscle volume (EMV). Clinical activity score (CAS) ≧ 3 was in active stage.Statistical TestsThe optimal cut‐off point of diagnostic efficacy was selected using receiver operating characteristic (ROC) curve analysis and evaluated using area under the curve (AUC), compared using Student's t test, analysis of variance or Kruskal–Wallis H test. The correlation used Pearson correlation analysis. The discriminant equation used a binary logistic regression analysis. P < 0.05 was considered statistically significant.ResultsThe SIRmean, SIRmax, T2RTmean, T2RTmax, EMA, and EMV in active GO patients were significantly higher than those in inactive and were positively correlated with CAS (r = 0.276, 0.228, 0.438, 0.388, 0.502, and 0333, respectively). The FFmax of active patients was significantly lower than that of inactive patients and was negatively correlated with CAS (r = −0.44). Logistic regression analysis indicated that T2RTmean was independently associated with GO active periods and had good diagnostic performance (area under ROC curve = 0.736, sensitivity 70.7%, specificity 69.3%). T2RTmean ≧ 74.295 could be a diagnostic cut‐off for judging GO activity (sensitivity 55.3%).ConclusionSIR, T2RT, EMV, and FF can quantitatively assess the activity and severity of GO and can potentially provide a basis for clinical judgment and selection of treatment options.Evidence Level4.Technical EfficacyStage 2.

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Asymmetry indicates more severe and active disease in Graves’ orbitopathy: results from a prospective cross-sectional multicentre study

Cited by 24 publications

References 26 publications

Asymmetric Graves’ Orbitopathy

Asymmetric Graves’ Orbitopathy

Epidemiology, Natural History, Risk Factors, and Prevention of Graves’ Orbitopathy

Application of Multiparameter Quantitative Magnetic Resonance Imaging in the Evaluation of Graves' Ophthalmopathy

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