Prevalence, Phenotype, and Psychosocial Well-Being in Euthyroid/Hypothyroid Thyroid-Associated Orbitopathy

Ponto, Katharina A.; Binder, Harald; Diana, Tanja; Matheis, N.; Otto, Anna F; Pitz, Susanne; Pfeiffer, Norbert; Kahaly, George J.

doi:10.1089/thy.2015.0031

Cited by 62 publications

(60 citation statements)

References 44 publications

(43 reference statements)

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“…Euthyroid/hypothyroid GO is a variant comprising of patients who are euthyroid, or have overt or subclinical hypothyroidism, before or within 6–12 months after the onset of GO and constitutes 0.2–11% of all cases of GO [29–33]. Patients with GO associated with dermopathy have characteristic skin changes and comprise 1.5% of all cases of GO [7].…”

Section: Resultsmentioning

confidence: 99%

Graves’ orbitopathy as a rare disease in Europe: a European Group on Graves’ Orbitopathy (EUGOGO) position statement

Perros

Hegedűs

Bartalena

et al. 2017

Orphanet J Rare Dis

129

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BackgroundGraves’ orbitopathy (GO) is an autoimmune condition, which is associated with poor clinical outcomes including impaired quality of life and socio-economic status. Current evidence suggests that the incidence of GO in Europe may be declining, however data on the prevalence of this disease are sparse. Several clinical variants of GO exist, including euthyroid GO, recently listed as a rare disease in Europe (ORPHA466682).The objective was to estimate the prevalence of GO and its clinical variants in Europe, based on available literature, and to consider whether they may potentially qualify as rare. Recent published data on the incidence of GO and Graves’ hyperthyroidism in Europe were used to estimate the prevalence of GO. The position statement was developed by a series of reviews of drafts and electronic discussions by members of the European Group on Graves’ Orbitopathy. The prevalence of GO in Europe is about 10/10,000 persons. The prevalence of other clinical variants is also low: hypothyroid GO 0.02–1.10/10,000; GO associated with dermopathy 0.15/10,000; GO associated with acropachy 0.03/10,000; asymmetrical GO 1.00–5.00/10,000; unilateral GO 0.50–1.50/10,000.ConclusionGO has a prevalence that is clearly above the threshold for rarity in Europe. However, each of its clinical variants have a low prevalence and could potentially qualify for being considered as a rare condition, providing that future research establishes that they have a distinct pathophysiology. EUGOGO considers this area of academic activity a priority.

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Section: Resultsmentioning

confidence: 99%

Graves’ orbitopathy as a rare disease in Europe: a European Group on Graves’ Orbitopathy (EUGOGO) position statement

Perros

Hegedűs

Bartalena

et al. 2017

Orphanet J Rare Dis

129

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“…Furthermore, it has been reported that both children [19] and adults with euthyroid orbitopathy [10,20,21] can test positive for TSAb and negative for TBII. Greater assay sensitivity might also lead to improved follow-up during the medical management of patients with Graves' hyperthyroidism and timing of treatment cessation.…”

Section: Discussionmentioning

confidence: 99%

Performance and Specificity of 6 Immunoassays for TSH Receptor Antibodies: A Multicenter Study

Diana¹,

Wüster²,

Olivo³

et al. 2017

Eur Thyroid J

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Background: The measurement of TSH receptor (TSHR) antibodies is warranted for diagnosis of Graves' disease (GD).Objective: The performance, detection sensitivity, and specificity of 6 TSHR immunoassays were compared. Methods: Two bioassays and 4 binding assays (Kronus, Immulite, Kryptor, Dynex) were compared in a dilution study performed in patients with autoimmune thyroid disease. Both bioassays were compared to 2 binding assays using stimulatory (M22) and blocking (K1-70) monoclonal antibody (MAb) mixtures. Results: Thirty samples from stimulatory (TSAb)-positive/blocking (TBAb)-negative patients with GD were diluted serially and measured in all assays. Samples were positive until dilution 1:2,187 in the TSAb bioassay, 1:81 in the Immulite (p < 0.002 vs. bioassay) and Kronus ELISA (p = 0.039) assays, and 1:27 in the Kryptor and Dynex ELISA (p < 0.001 vs. bioassay). Ten samples from TBAb-positive/TSAb-negative patients with GD or Hashimoto's thyroiditis were positive in all binding assays. None of the binding assays differentiated between TSAb and TBAb. Mixtures of 100% K1-70 (200 ng/ mL), 80% K1-70 + 20% M22, 60% K1-70 + 40% M22, 40% K1-70 + 60% M22, 20% K1-70 + 80% M22, and 100% M22 (20 ng/mL) tested positive in both Immulite (26.4, 20.2, 15.2, 10.5,6.3, 2.00 IU/L) and Kronus assays (27.1, 23.3, 19.3, 12.0, 5.7, 2.2 IU/L). These MAb mixtures were tested in the TBAb bioassay and showed 82, 61, 24 (negative), -26 (negative), -77 (negative), and -95% (negative) inhibition, respectively. Conclusions: The sample dilution study showed higher detection sensitivity for the TSAb bioassay, and the antibody mixture study demonstrated exclusive specificity of the bioassays over all automated and ELISA binding assays.

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“…In TED complicating Graves disease, TSHR ab levels correlate to TED severity [24] however, in TED complicating HT, TSHRab did not fluctuate but data on whether there was a correlation with severity or activity of TED was not reported [25]. However, mild eye disease, with symptoms such as grittiness, pruritis and upper eyelid retraction occurs in 25% of patients with HT [5] and TRAb levels as measured by TSI/Thyretin are negative [26], indicating the possibility of a different eye disease.…”

Section: Discussionmentioning

confidence: 99%

Sight Threatening Thyroid Eye Disease Complicating Hashimoto’s Thyroiditis

Young¹,

Depczynski²,

Wall³

et al. 2017

Endocrinol Metab Syndr

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A case of sight threatening thyroid eye disease (TED), arising in a 55 year old woman with primary hypothyroidism due to Hashimoto's thyroiditis (HT), is described. TSH receptor antibody (TSHRab) was positive as were orbital antibodies. Initial management consisted of methylprednisone intravenously followed by prednisone orally in a tapering dose, orbital irradiation and decompressive surgery. Visual acuity improved but 9 months later, there was evidence of relapse with features of compressive optic neuropathy, and exophthalmos had worsened. Prednisone dose was increased. At that time, TSHRab was negative. She underwent total thyroidectomy on the understanding that this was experimental therapy, surgery confirmed that thyroid pathology was solely TH without any evidence of Graves' disease. Prednisone was successively tapered without further relapse. Rehabilitative ocular muscle surgery is planned. Whether the improvement seen in TED can be attributed to effect of removal of thyroid antigens following thyroidectomy is purely speculative. Our case illustrates that relapsing sight threatening TED is part of spectrum of TED in HT and demonstrates that clinical features can be severe.

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Prevalence, Phenotype, and Psychosocial Well-Being in Euthyroid/Hypothyroid Thyroid-Associated Orbitopathy

Abstract: Compared with hyperthyroid TAO, QoL and working ability are less impaired in eu-/hypothyroid TAO with an often asymmetric and less severe clinical phenotype.

Cited by 62 publications

References 44 publications

Graves’ orbitopathy as a rare disease in Europe: a European Group on Graves’ Orbitopathy (EUGOGO) position statement

Graves’ orbitopathy as a rare disease in Europe: a European Group on Graves’ Orbitopathy (EUGOGO) position statement

Performance and Specificity of 6 Immunoassays for TSH Receptor Antibodies: A Multicenter Study

Sight Threatening Thyroid Eye Disease Complicating Hashimoto’s Thyroiditis

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