Predictive score for the development or progression of Graves’ orbitopathy in patients with newly diagnosed Graves’ hyperthyroidism

Wiersinga, Wilmar M.; Žarković, Miloš; Bartalena, Luigi; Donati, Simone; Perros, Petros; Okosieme, Onyebuchi; Morris, Daniel S.; Fichter, Nicole; Lareida, Jürg; Arx, Georg von; Daumerie, Chantal; Burlacu, Maria-Cristina; Kahaly, George J.; Pitz, Susanne; Beleslin, Biljana; Ćirić, Jasmina; Ayvaz, Göksün; Konuk, Onur; Törüner, Füsun Baloş; Salvi, Mario; Covelli, Danila; Currò, Nicola; Hegedűs, László; Brix, Thomas Heiberg; Eugogo,

doi:10.1530/eje-18-0039

Cited by 68 publications

(66 citation statements)

References 25 publications

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“…See my example linking text, but feel free to use your own text added] Approximately 2% of patients who develop Graves' orbitopathy will [Au: Addition for clarity OK? This is fine] develop moderate-severe disease 9,10 .…”

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confidence: 99%

“…2018 OK here? This is fine] proposed a predictive score of the risk of developing Graves' orbitopathy in Graves' disease with ocular inflammation at baseline; smoking, duration of thyroid dysfunction and especially the TSH-R-Ab titre were the four key risk factors 10 .This score, however, was more useful at identifying [Au: OK? This is fine] individuals who would not develop Graves' orbitopathy during treatment for Graves' disease rather than predicting which patients were at risk of developing Grave's orbitopathy 10 .…”

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confidence: 99%

“…This is fine] proposed a predictive score of the risk of developing Graves' orbitopathy in Graves' disease with ocular inflammation at baseline; smoking, duration of thyroid dysfunction and especially the TSH-R-Ab titre were the four key risk factors 10 .This score, however, was more useful at identifying [Au: OK? This is fine] individuals who would not develop Graves' orbitopathy during treatment for Graves' disease rather than predicting which patients were at risk of developing Grave's orbitopathy 10 . In October 2009, the Amsterdam Declaration, signed by over 80 organisations, proposed that the incidence and morbidity due to Graves' orbitopathy could be substantially reduced by preventive measures, such as warning patients about the early symptoms of Graves' orbitopathy, stopping smoking, avoiding hypothyroidism after radioactive iodine administration [ Au: Could you please provide 1 or 2 examples of preventative measures here?…”

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New insights into the pathogenesis and nonsurgical management of Graves orbitopathy

et al. 2019

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Graves' orbitopathy, also known as thyroid eye disease or thyroid-associated orbitopathy, is visually disabling, cosmetically disfiguring and has a substantial negative impact on a patients' quality of life. There is increasing awareness of the need for early diagnosis and rapid specialist input from endocrinologists and ophthalmologists. Glucocorticoids are the mainstay of treatment; however, recurrence occurs frequently once these are withdrawn. Furthermore, in >60% of cases, normal orbital anatomy is not restored, and skilled rehabilitative surgery is required to reduce disfigurement, double vision and occasionally, to preserve vision. Clinical trials from over the past decade [Au: edits to define "recent" OK? Please edit my changes if I have misunderstood you This is fine] have shown that considerable benefit can be derived from the addition of anti-proliferative agents (such as mycophenolate or azathioprine) in preventing deterioration after steroid cessation. In addition, targeted biologic therapies have shown promise, including teprotumumab (anti-IGF-1R), which seems to substantially reduce proptosis, rituximab (anti-CD20), which reduces inflammation, and tocilizumab, which potentially benefits both of these parameters. Other strategies such as orbital radiotherapy have had their widespread role in combination therapy called into question. In the last decade, the pathophysiology of Graves' orbitopathy has also been revised with identification of new potential therapeutic targets. In this review we provide an up-to-date overview of the field, [Au: addition of linking text OK? This is fine] outline the optimal management of Graves' orbitopathy and summarise the research developments in this area to highlight future research questions and direct future clinical trials.

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New insights into the pathogenesis and nonsurgical management of Graves orbitopathy

et al. 2019

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“…The European Group on Graves' Orbitopathy (EUGOGO) conducted a multicenter prospective cohort study in 348 newly diagnosed untreated GH patients without overt GO in order to construct a predictive score for developing GO during an 18-month ATDs treatment course (64). The determinants assessed at baseline and before the ATDs initiation were age, sex, family history of AITD, other autoimmune diseases, duration of hyperthyroid symptoms, biochemical and immunologic severity of hyperthyroidism (TSH, fT4, fT3, TBII, TPOAb), smoking status (never smoker, exsmoker, current smoker), clinical activity score (CAS) and the Vancouver Orbitopathy Rule (65).…”

Section: Prediction Of the Development Of Go: The Predigo Scorementioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Predictive scores in autoimmune thyroid disease: are they useful?

Effraimidis

2019

European Journal of Endocrinology

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Prediction models are of a great assistance for predicting the development of a disease, detecting or screening undiagnosed patients, predicting the effectiveness of a treatment and helping toward better decision-making. Recently, three predictive scores in the field of autoimmune thyroid disease (AITD) have been introduced: The Thyroid Hormones Event Amsterdam (THEA) score: a predictive score of the development of overt AITD, the Graves’ Events After Therapy (GREAT) score: a prediction score for the risk of recurrence after antithyroid drugs withdrawal and the Prediction Graves’ Orbitopathy (PREDIGO) score: a prediction score for the development of Graves’ orbitopathy in newly diagnosed patients with Graves’ hyperthyroidism. Their construction, clinical applicability, the possible preventative measurements which can be taken to diminish the risks and the potential future developments which can improve the accuracy of the predictive scores are discussed in this review.

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“…Manifestation of GO in GD patients is correlated with elevated serum concentrations of TSHR antibodies and severe hyperthyroidism 9 , 10 . Risk factors for development or worsening of GO are gender, age and multiple genetic variabilities in combination with exogenous factors like smoking, stress, infections or iodine intake 6 , 7 . Of note, among risk factors, female gender appears to conferr a greater risk than any other single factor for development of GO where depending on the different populations examined GO is found with female-to-male ratio of 4 to 6 11 – 14 .…”

Section: Introductionmentioning

confidence: 99%

Graves’ orbitopathy occurs sex-independently in an autoimmune hyperthyroid mouse model

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Díaz‐Cano

et al. 2018

Sci Rep

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Graves’ orbitopathy (GO) is the most common extra thyroidal complication of Graves’ disease (GD) and occurs predominantly in women but more severe in men. The reason for this effect of gender on GO is unknown. Herein we studied the manifestation of GO in both sexes of an induced mouse model in absence of additional risk factors present in patients like advanced age, genetic variabilities or smoking. Male and female mice were immunized with human TSHR A-subunit encoding plasmid. Both sexes comparably developed autoimmune hyperthyroidism characterized by TSHR stimulating autoantibodies, elevated T4 values, hyperplastic thyroids and hearts. Autoimmune mice developed inflammatory eye symptoms and proptosis, although males earlier than females. Serial in vivo 1H/19F-magnetic resonance imaging revealed elevated inflammatory infiltration, increased fat volume and glycosaminoglycan deposition in orbits of both sexes but most significantly in female mice. Histologically, infiltration of T-cells, extension of brown fat and overall collagen deposition were characteristics of GO in male mice. In contrast, female mice developed predominately macrophage infiltration in muscle and connective tissue, and muscle hypertrophy. Apart from sex-dependent variabilities in pathogenesis, disease classification revealed minor sex-differences in incidence and total outcome. In conclusion, sex does not predispose for autoimmune hyperthyroidism and associated GO.

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Predictive score for the development or progression of Graves’ orbitopathy in patients with newly diagnosed Graves’ hyperthyroidism

Cited by 68 publications

References 25 publications

New insights into the pathogenesis and nonsurgical management of Graves orbitopathy

New insights into the pathogenesis and nonsurgical management of Graves orbitopathy

MANAGEMENT OF ENDOCRINE DISEASE: Predictive scores in autoimmune thyroid disease: are they useful?

Graves’ orbitopathy occurs sex-independently in an autoimmune hyperthyroid mouse model

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