Clinical Management and Therapeutic Strategies for the Thyroid-Associated Ophthalmopathy: Current and Future Perspectives

Mishra, Sanjeev Kumar; Maurya, Vimal K.; Kumar, Sanjeev; Ankita, .; Kaur, Apjit; Saxena, Shailendra K.

doi:10.1080/02713683.2020.1776331

Cited by 31 publications

(29 citation statements)

References 90 publications

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“…As for limits, this study is a single-centre study conducted with a relatively homogeneous population (race/ethnicity), which may limit the application of the developed prediction model to other populations since the presentations of GO are different in Asian and Western populations due to anatomical, immunological, genetic, socioeconomic and Open access environmental variability. 31 In the baseline data collection process, structured recording of medical history information and standardised collection of multiple indicators lay a solid foundation for the following statistics processing and analysis, but also add to the complexity and repetitive work of the study. In addition, after establishing the prediction model, new patients need to be recruited to conduct diagnostic tests with 5% error and 95% confidence level to verify the reported sensitivity and specificity of the model, so as to assess the clinical application value of it, which poses high requirements for the treatment management and data management work of the project.…”

Section: Discussionmentioning

confidence: 99%

Novel observational study protocol to develop a prediction model that identifies patients with Graves’ ophthalmopathy insensitive to intravenous glucocorticoids pulse therapy

Wang

et al. 2021

BMJ Open

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IntroductionIntravenous glucocorticoids pulse therapy is the first-line treatment for moderate-to-severe and active Graves’ ophthalmopathy, with a large proportion of patients having poor efficacy and exposed to the risk of glucocorticoids adverse effects. We introduce a novel protocol to develop a prediction model designed to identify patients with Graves’ ophthalmopathy who are not likely to benefit from intravenous glucocorticoids pulse therapy before administration, so that these patients can advance the time to receive appropriate treatment. Existing prediction models for prognosis of Graves’ ophthalmopathy have usually focused on traditional clinical indicators without adequate consideration of orbital soft tissue changes. Our protocol for model development will address this limitation by using artificial intelligence models to quantify facial morphological changes.Methods and analysisThis study is a single-centre, prospective and observational study. A sample size of 278 patients with moderate-to-severe and active Graves’ ophthalmopathy will be prospectively recruited at ophthalmology clinic of Shanghai Ninth People’s Hospital to collect clinical and artificial intelligence model’s baseline data as potential variables to develop the prediction model. They will receive 12-week intravenous glucocorticoids pulse therapy according to the 2021 European Group on Graves’ Orbitopathy treatment guideline. After standard medication course and following 12-week observation, patients will be evaluated for the effectiveness of treatment in our ophthalmology clinic and divided into glucocorticoids-sensitive and glucocorticoids-insensitive groups. The model will be developed by means of multivariate logistic regression to select the best variables for the prediction of glucocorticoids treatment efficacy before administration. The result of the study will provide evidence for the use of a prediction model to personalise treatment options for patients with moderate-to-severe and active Graves’ ophthalmopathy.Ethics and disseminationThe study received approval from the Ethics Committee of Shanghai Ninth People’s Hospital (ethical approval number: SH9H-2020-T211-1. Findings will be disseminated via peer-reviewed publications and conference presentations.Trial registration numberChiCTR2000036584 (Pre-results).

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Section: Discussionmentioning

confidence: 99%

Novel observational study protocol to develop a prediction model that identifies patients with Graves’ ophthalmopathy insensitive to intravenous glucocorticoids pulse therapy

Wang

et al. 2021

BMJ Open

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“…Avoidance of glucocorticoid treatment side‐effects and improvement in treatment efficacy are major goals for the field of GO (Mishra et al. 2020). Therefore, a balance between potential harms and benefits of intervention should be underscored.…”

Section: Discussionmentioning

confidence: 99%

“…EUGOGO recommends that IVGC is a safe treatment for the liver when cumulative doses do not exceed 8 g (Bartalena et al 2016). Avoidance of glucocorticoid treatment side-effects and improvement in treatment efficacy are major goals for the field of GO (Mishra et al 2020). Therefore, a balance between potential harms and benefits of intervention should be underscored.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of different treatment modalities for active, moderate‐to‐severe Graves' orbitopathy: a systematic review and network meta‐analysis

Yang

Song

et al. 2021

Acta Ophthalmologica

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To compare the effects of different treatment modalities on active, moderate-tosevere Graves' orbitopathy (GO). We searched PubMed and Embase for randomized controlled trials published up to 30 Nov 2020, of different modalities for the treatment of active, moderate-to-severe GO. We performed Bayesian network meta-analyses. This study is registered with PROSPERO (CRD42020166287). Fifteen RCTs were identified. Network meta-analysis showed that in comparison with placebo, teprotumumab, mycophenolate plus intravenous glucocorticoids (IVGCs), mycophenolate, rituximab, azathioprine, IVGCs, orbital radiotherapy, oral glucocorticoids (OGCs) were effective treatments (ordered from most effective to least effective). Teprotumumab was more efficacious in reducing proptosis than IVGCs. No significant difference in changes in diplopia grade was recorded between teprotumumab, rituximab, orbital radiotherapy and IVGCs. Low (4.5-5 g), middle (6 g) and high (7-8 g) cumulative doses of IVGCs were shown to be more effective than OGC in improving the overall response rate, but the very low-group (<3 g) seemed to have a lower risk of adverse events. We found that teprotumumab offered the highest level of efficacy in terms of the overall response rate and was more efficacious in reducing proptosis than IVGCs. With regard to different dosages of IVGCs, the cumulative dose of 4.5-5 g of IVGCs seems to be the most appropriate schedule in terms of efficacy and safety outcomes. Due to the limited number of patients treated with teprotumumab and the lack of comparison with other effective therapeutics, teprotumumab might not become the standard firstline therapy for active, moderate-to-severe GO.

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“…Orbitopathy develops in 25%-50% of patients with Graves' disease and a few (2%) with Hashimoto's thyroiditis. TAO may precede, occur simultaneously, or follow the onset of abnormal thyroid function (4)(5)(6)(7). Ultrasonography (US), magnetic resonance imaging (MRI) and computed tomography (CT), can be used as imaging modalities.…”

Section: Introductionmentioning

confidence: 99%

Orbital MRI in thyroid-associated orbitopathy

Deniz

Turmak

Pekkolay

et al. 2022

Anatolian Current Medical Journal

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Aim: Thyroid-associated orbitopathy (TAO) is the most common cause of proptosis in adults and the clinical picture is mostly associated with thyroid dysfunction. MRI is frequently used because of its advantages, such as high soft tissue resolution, multiple plane evaluation, and no risk of ionizing radiation exposure to the lens. The research aim was to present cases of thyroid orbitopathy with MRI findings and to compare the findings with existing literature. Material and Method:Patients who visited our radiology clinic with a preliminary diagnosis of TAO between April 2015 and February 2021 and underwent orbital MRIs were included in the study. We evaluated parameters such as age, sex, presence of proptosis, orbital muscle involvement, increase in orbital fatty tissue, and lacrimal gland involvement.Results:A total of 35 patients were included in our study. The mean age was 40.6 (18-60) years, 19 (54%) patients were female, and 16 (46%) were male. All patients were diagnosed with Graves' disease, whereas no patient was diagnosed with Hashimoto's thyroiditis. The most common findings were proptosis in 33 (94%) patients, inferior rectus involvement in 27 (77%) patients, and medial rectus muscle involvement in 25 (71%) patients. No significant correlation was found between the presence of uni/ bilateral involvement and TSH values (p = 0.008). Conclusion:In conclusion, since the presence of orbital involvement is crucial for treating thyroid diseases, all orbital structures involved should be reported by imaging. Orbital MRI is an effective imaging modality in the detection and differential diagnosis of TAO.

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Clinical Management and Therapeutic Strategies for the Thyroid-Associated Ophthalmopathy: Current and Future Perspectives

Cited by 31 publications

References 90 publications

Novel observational study protocol to develop a prediction model that identifies patients with Graves’ ophthalmopathy insensitive to intravenous glucocorticoids pulse therapy

Novel observational study protocol to develop a prediction model that identifies patients with Graves’ ophthalmopathy insensitive to intravenous glucocorticoids pulse therapy

Comparative effectiveness of different treatment modalities for active, moderate‐to‐severe Graves' orbitopathy: a systematic review and network meta‐analysis

Orbital MRI in thyroid-associated orbitopathy

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