Effect of abnormal thyroid function on the severity of Graves' ophthalmopathy

Prummel, M. F.

doi:10.1001/archinte.150.5.1098

Cited by 54 publications

(31 citation statements)

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“…In a study of 87 patients with Graves' disease followed for more than 5 months, no substantial changes in ocular condition were observed among the 54 patients who were euthyroid at the time of first observation; conversely, among the 33 patients who were hyperthyroid when first seen, eye disease progressively improved with time after restoration of euthyroidism, as assessed by the decrease in the total eye score (16). In a consecutive-entry study, 287 patients with Graves' disease were subdivided into four groups (A to D) according to increasing severity of ocular involvement and the proportion of hyperthyroid patients was found to be greater in patients with more severe ophthalmopathy (group C, 61%; group D, 47%) than in those with milder expressions of the disease (group A, 23%; group B, 32%) (17).…”

Section: Preventable Risk Factorsmentioning

confidence: 99%

Graves' ophthalmopathy: a preventable disease?

Bartalena

Marcocci

Pinchera

2002

European Journal of Endocrinology

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Most patients with Graves' disease have some degree of ocular involvement, but only 3-5% of them develop severe ophthalmopathy (1). The reasons why only such a minority of patients with Graves' disease have severe expression of the ophthalmopathy remain to be elucidated. One possible explanation is that non-severe ophthalmopathy and severe ophthalmopathy are two different disorders with different genetic backgrounds; alternatively, they might be part of a spectrum of different conditions ranging from absent ocular involvement to most severe ophthalmopathy. In this case, external variables (i.e. environmental factors) must contribute to the nature of the expression of the disease. How important are they? How far can our intervention on environmental factors go towards reducing the risk of progression of the ophthalmopathy? In other words, to which extent, if any, is Graves' ophthalmopathy preventable? The aim of this mini-review is to address the above issues.

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Section: Preventable Risk Factorsmentioning

confidence: 99%

Graves' ophthalmopathy: a preventable disease?

Bartalena

Marcocci

Pinchera

2002

European Journal of Endocrinology

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“…The first step in the treatment of GO is controlling the thyroidal disease, as achieving euthyroidism improves ocular symptoms (3). The next step is to distinguish active GO from burnt-out GO, for which the clinical activity score (CAS), based on the classical signs of inflammation, is commonly used (4,5).…”

Section: Introductionmentioning

confidence: 99%

Methylprednisolone pulse therapy for patients with moderately severe Graves' orbitopathy: a prospective, randomized, placebo-controlled study

Geest¹,

Sasim²,

Koppeschaar³

et al. 2008

European Journal of Endocrinology

109

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Objective: To assess whether methylprednisolone (MP) pulse therapy is efficacious in the treatment of moderately severe Graves' orbitopathy (GO). Design: Prospective, placebo (PL)-controlled, double-blind, randomized study. Methods: Fifteen previously untreated patients with active, moderately severe GO participated in the study; 6 patients received MP and 9 patients a PL. Moderately severe disease was defined using the NOSPECS classification of clinical signs of GO . Activity was measured with the clinical activity score (CAS). A dose of 500 mg MP or only solvent was administered intravenously, over three consecutive days, in four cycles at 4 weekly intervals (6 g of MP in total). Qualitatively, a successful treatment outcome was defined as an improvement in one major and/or two minor criteria in the worst eye at week 48. The major criteria were: improvement in diplopia grade; improvement in eye movement; a decrease in CAS of three points. The minor criteria were: decrease of eyelid retraction; decrease of proptosis; improvement in grade of soft tissue swelling; a decrease in CAS of two points. Results: The qualitative treatment outcome was successful at the end of the trial in five out of six (83%) patients receiving MP and in one out of nine (11%) patients given the PL (relative riskZ7.5; (95% confidence interval 1.1-49.3), PZ0.005). The treatment was well tolerated. Conclusions: In spite of the small number of patients, a significant difference in outcome was observed between MP-and PL-treated patients. We conclude that MP pulse therapy appears to be an effective treatment for active, moderately severe GO.European Journal of Endocrinology 158 229-237

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“…In 15 of the patients, treatmentinduced hypothyroid episodes were followed by an exacerbation of the eye disease. In a retrospective study of 90 patients with TAO, Prummel et al (11) also found that dysthyroidism was associated with more severe Graves' ophthalmopathy. Furthermore, Kung et al (12) showed that development of hypothyroidism with rising thyrotropin (TSH) levels after 131 I therapy for GD was associated with a greater risk of development or exacerbation of ophthalmopathy.…”

Section: Thyroid Functionmentioning

confidence: 95%