Clinical characteristics of moderate-to-severe thyroid associated ophthalmopathy in 354 Chinese cases

Abstract

Thyroid associated ophthalmopathy (TAO) is an autoimmune inflammatory disorder which disfigures appearance, threatens vision, and results in a pronounced loss of quality of life. The diversity and ethnic difference of the disease manifestations have made it difficult to tailor therapies for each patient. Few studies have analyzed its characteristics in Chinese populations. We therefore enrolled 354 patients with moderate-to-severe TAO from February 2015 to July 2016. A single ophthalmologist consistently performed detailed ophthalmic examinations. Orbital computed tomography or magnetic resonance imaging scans were performed to verify enlarged extraocular muscles. Multiple linear regression was used to analyze the association between sex, age, smoking, family history of thyroid diseases, degree of proptosis and disease severity. The mean age of males (46.56±11.08 years) was significantly higher than that of females (41.39±years), with a female-to-male ratio of 1.09. The females and males between 31~40 and 41~50 years, respectively, had the highest incidence of TAO. 81.48% of the patients suffered hyperthyroidism. TAO was diagnosed either after (47.17%) or simultaneously with thyroid dysfunction (27.68%). Proptosis (91.24%), eyelid retraction (83.33%), together with eyelid swelling (79.38%) and extraocular muscle enlargement (75.42%), were the most common clinical sign. 19.77% of patients manifested lower eyelid retraction. The mean values of exophthalmos and asymmetry on proptosis were 19.94±3.45mm and 2.18±2.06mm, respectively in males, 18.58±3.31mm and 1.61±1.53mm, respectively in females. The severity of disease was significantly associated with male, older age, smoking, family history of thyroid diseases and degree of proptosis. We found several differences in Chinese compared with White. The female-to-male ratio and mean value of exophthalmos were significantly lower than the data of White. Inferior and superior rectus became the most common extraocular muscles. Lower eyelid retraction should be included in diagnostic criteria in Asian patients. Understanding these differences, may allow better identification and treatment for TAO in China.

Clinical outcomes of graves’ ophthalmopathy treated with intensity modulated radiation therapy

“…Because it is a radiotherapy treatment method and has a relevant higher price, there is a trend towards more serious disease status in the cohort. According to a study concerning the clinical characteristics of moderate-to-severe GO in Chinese patients which included 354 patients [ 23 ], 52.26% were female patients, which was similar to our study. The underline reasons may be due to that, firstly, the female-to-male ratio decreases correspondingly with the severity of the disease [ 24 ], and secondly, the predominance of females over males in the incidence of GO was considerably less in Asian patients [ 25 ].…”

“…The underline reasons may be due to that, firstly, the female-to-male ratio decreases correspondingly with the severity of the disease [ 24 ], and secondly, the predominance of females over males in the incidence of GO was considerably less in Asian patients [ 25 ]. Thirdly, in China, female patients tend to choose primary and second level hospitals for medical service at the beginning of the illness, while male patients always wait and endure until the disease progressed to an unbearable condition [ 23 ], and they always concentrate in tertiary hospitals like our center. Thus, it was rational to found that our cohorts consists a relatively high proportion of male patients.…”

Clinical profile of thyroid eye disease and factors predictive of disease severity

“…[ 11 ] It was also much higher than that reported by studies from Southeast Asia (2.3% hypothyroid, 11.5% euthyroid) and China (4.5% hypothyroid, 11.3% euthyroid). [ 4 14 ] In a study from India by Khurana et al ., there were 36.67% patients with euthyroid and none had hypothyroidism. [ 7 ] Since the most patients could not afford an antibody profile, subclinical disease could have been missed since antibodies can be positive in the presence of normal thyroid status.…”

Histopathologic study of extraocular muscles in thyroid-associated ophthalmopathy coexisting with ocular myasthenia gravis: a case report

“…These findings collectively suggest that coexistence of TAO and OMG may follow a distinct pathogenic process rather than an overlapping process of TAO and OMG. Notably, a growing evidence supports the concept that the male TAO patients are more prone to develop active and severe clinical symptoms than the female patients [12]. Previous studies also unveiled a gender bias in co-occurrence of thyroid disease and MG, suggesting that the prevalence in female population was higher than the male population [9,10].…”