Nationwide Incidence of Thyroid Eye Disease and Cumulative Incidence of Strabismus and Surgical Interventions in Denmark

Boulakh, Lena; Nygaard, Birte; Bek, Toke; Faber, Jens; Heegaard, Steffen; Toft, Peter Bjerre; Poulsen, Henrik Enghusen; Toft-Petersen, Anne Pernille; Hesgaard, Helena Buch; Ellervik, Christina

doi:10.1001/jamaophthalmol.2022.1002

Cited by 10 publications

(6 citation statements)

References 25 publications

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“…The prevalence is higher in women, although the femaleto-male ratio (F/M) varies depending on the study. However, all studies show that the F/M ratio is lower compared to GD (GD: 3.4-5.6; GO: 2.1-4.2) (16)(17)(18)(19). Furthermore, F/M ratio gets lower with higher severity of GO (mild 9.3, moderate 3.2, sight threatening 1.4) (20,21).…”

Section: Introductionmentioning

confidence: 96%

Influence of biological sex, age and smoking on Graves’ orbitopathy – a ten-year tertiary referral center analysis

et al. 2023

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PurposeSeverity of Graves’ orbitopathy (GO) shows wide individual differences. For optimal treatment, it is important to be able to predict the natural course of the disease as accurate as possible to counteract with anti-inflammatory and surgical treatment. Therefore, we aimed to further elucidate the impact of sex, age and smoking on GO.MethodsWe collected the clinical and demographic data of all patients of our tertiary referral center from January 2008 till December 2018 and analyzed it with descriptive statistics. Only patients with a complete data set were included in the further analysis. Odds ratio’s for moderate-to-severe and sight-threatening GO in relation to age, sex and smoking were calculated by means of multivariate logistic regression models.ResultsWe evaluated the data of 4260 patient with GO and complete data sets. Most of these were women (83%). There were no significant differences between male and female patients regarding smoking habits and thyroid treatment. Men were significantly older at initial manifestation of TED (51.8 vs. 49.9y, p<0.01) and showed significant more often severe stages (61% vs. 53%, p<0.0001). Therefore, they needed significantly more intense treatment with steroids, irradiation, orbital decompression and muscle surgery. In multivariate logistic regression analyses age (OR 0.97, 95% CI:0.97-0.98, p<0.0001), male sex (OR 1.64, 95% CI:1.38-1.9, p<0.0001), smoking (OR 1.19, 95% CI:1.04-1.36, p=0.01), Grave’s disease (OR 1.55, 95% CI:1.26-1.90, p<0.0001) and history of radioiodine treatment (RAI) (OR 2.44, 95% CI:2.10-2.86, p<0.0001) showed an significant association with severe stages of GO.DiscussionOur retrospective analysis showed once more that women are more often afflicted by GO. In contrast, men seem to be more severely afflicted and in need of anti-inflammatory and surgical treatments. This might be due to a different approach to the health system and resilience to GO specific symptoms, as well as previously described worse thyroid control. Estrogen mediated effects might also play a role as in other autoimmune diseases and should be subject of further trials. Besides the biological sex, smoking could again be confirmed as serious risk factor for severe GO. Of note, RAI was associated with more severe stages of GO, which should be subject to further investigation.

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Section: Introductionmentioning

confidence: 96%

Influence of biological sex, age and smoking on Graves’ orbitopathy – a ten-year tertiary referral center analysis

et al. 2023

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“…According to Bartley (1994), the age-adjusted incidences of GO were 16 and 2.9 per 100,000 person-years in women and men, respectively ( 8 ). A recent Danish study investigated the nationwide incidence of thyroid eye disease (TED), a synonym of GO ( 9 ). The mean annual nationwide incidences of TED were 8.0 and 1.9 per 100,000 person-years in women and men, respectively; the mean incidence was 5.0 in the overall population, which included both women and men.…”

Section: Introductionmentioning

confidence: 99%

“…In 2008, a nationwide cohort study in Denmark revealed that the incidence of diplopia in GO patients was approximately 17-51% ( 19 ). The 4-year cumulative incidence of strabismus was 10%, and 8% of such cases required surgery ( 9 ). A multidisciplinary approach combining medical and surgical strategies may benefit GO patients.…”

Section: Introductionmentioning

confidence: 99%

Update on the surgical management of Graves’ orbitopathy

et al. 2023

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Graves’ orbitopathy (GO) is a complex autoimmune disorder of the orbit that causes the eye to appear disfigured. GO is typically associated with Graves’ disease, an inflammatory autoimmune condition that is caused by thyrotropin receptor autoantibodies. Although our knowledge of the pathophysiology of GO has improved, its exact pathogenesis remains unclear. Some patients suffer from disfigurement, double vision, and even vision loss rather than hyperthyroidism. The disease severity and activity prompt different treatments, as the signs of GO are heterogeneous, so their management can be very complex. Despite medical advances, the first-line treatment for moderate-to-severe active GO is still glucocorticoids, while surgery can be critical for the treatment of chronic inactive GO. Surgery is sometimes required in the acute phase of the disease when there is an immediate risk to vision, such as in dysthyroid optic neuropathy. Most surgeries for GO are rehabilitative and subdivided into three categories: decompression, strabismus repair, and lid surgery. This review is a basic overview of the field, with up-to-date knowledge of the surgical techniques for GO. We review and summarize recent literature on the advances in surgery for GO to provide up-to-date insights on the optimal surgical treatment for GO.

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“…Thyroid eye disease (TED), also known as thyroid-associated orbitopathy or Graves ophthalmopathy, is an autoimmune inflammatory disease related to hyperthyroidism or hypothyroidism. However, some TED patients presented as euthyroid [1,2]. TED patients are usually characterized by deformation, diplopia, visual dysfunction, dry eye, and decreased quality of life.…”

Section: Introductionmentioning

confidence: 99%

Ocular Surface Changes in Treatment-Naive Thyroid Eye Disease

Liao

Lai

Aljufairi

et al. 2023

JCM

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Objective: To investigate the association of meibomian gland dysfunction (MGD) and ocular surface exposure with tear film instability in untreated thyroid eye disease (TED) patients. Methods: A cross-sectional study of TED patients from September 2020 to September 2022 was conducted. Ocular surface parameters included ocular surface disease index (OSDI), tear meniscus height (TMH), non-invasive tear break-up time (NITBUT), partial blinking rate, lipid layer thickness (LLT), meibomian gland dropout (meiboscore), Schirmer’s test, and corneal punctate epithelial erosions (PEE). Ocular surface exposure was assessed by the margin reflex distances of the upper and lower eyelid (MRD1 and MRD2), the amount of exophthalmos, lateral flare, and lagophthalmos. Results: In total, 152 eyes from 76 TED patients (64 females and 12 males, age 42.99 ± 12.28 years) and 93 eyes from 61 healthy controls (51 females and 10 males, age 43.52 ± 17.93 years) were examined. Compared with control eyes, TED eyes had higher OSDI, TMH, LLT, and PEE; shorter NITBUT; and worse meiboscore (all p < 0.05). They also had larger amounts of exophthalmos, longer MRD1, more lateral flare, and lagophthalmos. Multivariate analysis identified an association of the tear film instability with lagophthalmos (β = −1.13, 95%CI: −2.08, −0.18) and severe MGD in the lower eyelid (β = −5.01, 95%CI = −7.59, −2.43). Conclusions: Dry eye in TED is mainly manifested as evaporative dry eye disease. Severe lower eyelid MGD and worse lagophthalmos were significantly associated with tear film instability in treatment-naive TED patients.

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Nationwide Incidence of Thyroid Eye Disease and Cumulative Incidence of Strabismus and Surgical Interventions in Denmark

Cited by 10 publications

References 25 publications

Influence of biological sex, age and smoking on Graves’ orbitopathy – a ten-year tertiary referral center analysis

Influence of biological sex, age and smoking on Graves’ orbitopathy – a ten-year tertiary referral center analysis

Update on the surgical management of Graves’ orbitopathy

Ocular Surface Changes in Treatment-Naive Thyroid Eye Disease

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