Proptosis in Dysthyroid Ophthalmopathy: A Case Series of 10,931 Japanese Cases

Kozaki, Ai; Inoue, Ryo; Komoto, N.; Maeda, Toshine; Inoue, Yoshio; Inoue, Toshu; Ayaki, Masahiko

doi:10.1097/opx.0b013e3181ce5702

Cited by 28 publications

(26 citation statements)

References 16 publications

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“…Lid swelling is observed in 47% of GO patients, with injection and edema of the conjunctiva observed in 32% (29).…”

Section: Clinical Presentationmentioning

confidence: 99%

“…The female to male ratio is 4.2 in Swedish patients (31) and 3.9 in Japanese subjects (29). Moreover, the female to male ratio varies according to the severity of ophthalmopathy, being 9.3, 3.2 and 1.4 in patients with mild, moderate and severe ophthalmopathy, respectively (28).…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Bimodal peaks in age onset have been observed in both men and women, with both peaks occurring five years earlier in women than in men (40-44 years vs. 45-49 years and 60-64 years vs. 65-69 years) (7). In an observational case series of 10,931 consecutive Japanese patients with GO treated at one clinic from 1993 to 2002, the mean age at GO onset was 39.1 years in women and 43.0 years in men (29).…”

Section: Clinical Presentationmentioning

confidence: 99%

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Graves' Ophthalmopathy: Epidemiology and Natural History

et al. 2014

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Graves' ophthalmopathy (GO) is an autoimmune disorder of the orbit that is clinically relevant in 25-50% of patients with Graves' disease and 2% of patients with chronic thyroiditis. The age-adjusted annual incidence of clinically relevant GO is 16 per 100,000 population in women and 2.9 in men. At the onset of ophthalmopathy, 80-90% of patients have hyperthyroidism, with the rest having euthyroidism or hypothyroidism. The natural history of GO consists of two phases: an active inflammatory phase and a static phase. Antiinflammatory therapy is indicated for the first phase of GO. Approximately 5% of patients experience late reactivation of GO. Asians appear to have less severe manifestations, with milder orbital edema, proptosis and muscle restriction. Genetic, anatomic and environmental factors influence the development of GO. Aging, thyroid dysfunction, thyroid stimulating hormone (TSH) receptor antibodies, smoking and radioiodine treatment for hyperthyroidism also influence the development and course of GO.

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“…Lid swelling is observed in 47% of GO patients, with injection and edema of the conjunctiva observed in 32% (29).…”

Section: Clinical Presentationmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

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Graves' Ophthalmopathy: Epidemiology and Natural History

et al. 2014

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“…Kozaki et al noted clinically significant proptosis (>/=15 mm) in 74.2% of adult patients. The average exophthalmometer reading was 17.2 +/-3.2 mm, with proptosis less pronounced with age [24].…”

Section: Clinical Signmentioning

confidence: 90%

“…Kozaki et al (2010) showed lid retraction in 57.7% of adult patients [24]. Eyelid retraction may be of thyroid hormone excess, an increased stimulation of the eyelid retractors or innervation of the superior rectus/levator muscles and contracture, overactivity of Muller's muscle, contracture of inferior rectus muscle [23,24].…”

Section: Clinical Signmentioning

confidence: 99%

Clinical Ocular Features in Children and Young Adults with Thyroid Diseases

Jankauskienė¹,

Jarušaitienė²

2017

Thyroid Disorders Ther

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The study of clinical ocular manifestations recruited 105 patients who presented to the Endocrine and Eye clinics of Lithuanian University of Medical Sciences with a history of thyroid diseases. The study comprised two groups of patients: the group I included 36 patients (under 18 years) and the group II-69 (from 18 to 34 years). As the control group, 25 children and 30 young adults of similar age without thyroid, eye and systemic diseases were selected.A comprehensive ophthalmic assessment including patient's complaints, best-corrected Snellen visual acuity, ocular motility, proptosis measurements, intraocular pressure (IOP), eyelid signs (lid aperture, lid retraction), slit lamp and fundus investigation was performed.Our investigation confirms that in children with thyroid diseases ocular symptoms and signs such as upper eyelid retraction, stare and mild proptosis were predominant. Young adults with thyroid diseases complained of foreign body sensation, photosensitivity and pain. There was manifestation of eyelid retraction, eyelid oedema and redness, conjunctival redness and chemosis, eyelid retraction, proptosis and widened palpebral fissure. A small number of young adults with thyroid diseases suffered from severe ocular complications as keratopathy, diplopia.This examination may be useful in early diagnosis of ocular changes in children and young adults with thyroid diseases.

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Application of Multiparameter Quantitative Magnetic Resonance Imaging in the Evaluation of Graves' Ophthalmopathy

Luo

Feng

et al. 2023

Magnetic Resonance Imaging

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BackgroundAssessment of the activity of Graves' ophthalmopathy (GO) is difficult. Existing methods need improvement.PurposeInvestigate the application of multiparametric magnetic resonance imaging (MRI) in GO.Study TypeRetrospective.PopulationA total of 235 GO patients (age: 38.8 ± 13.4 years; 90 male; 96 active patients).Field Strength/SequenceShort‐tau inversion recovery (STIR) fast spin echo, multiecho spin echo T2 mapping and 3D T1‐weighted fast field echo sequences at 3.0 T.AssessmentTwo physicians assessed the mean and maximum signal intensity ratio of extraocular muscles to white matter (SIR), T2 relaxation time (T2RT), extraocular muscle area (EMA), fat fraction (FF), retrobulbar fat volume (RFV), and extraocular muscle volume (EMV). Clinical activity score (CAS) ≧ 3 was in active stage.Statistical TestsThe optimal cut‐off point of diagnostic efficacy was selected using receiver operating characteristic (ROC) curve analysis and evaluated using area under the curve (AUC), compared using Student's t test, analysis of variance or Kruskal–Wallis H test. The correlation used Pearson correlation analysis. The discriminant equation used a binary logistic regression analysis. P < 0.05 was considered statistically significant.ResultsThe SIRmean, SIRmax, T2RTmean, T2RTmax, EMA, and EMV in active GO patients were significantly higher than those in inactive and were positively correlated with CAS (r = 0.276, 0.228, 0.438, 0.388, 0.502, and 0333, respectively). The FFmax of active patients was significantly lower than that of inactive patients and was negatively correlated with CAS (r = −0.44). Logistic regression analysis indicated that T2RTmean was independently associated with GO active periods and had good diagnostic performance (area under ROC curve = 0.736, sensitivity 70.7%, specificity 69.3%). T2RTmean ≧ 74.295 could be a diagnostic cut‐off for judging GO activity (sensitivity 55.3%).ConclusionSIR, T2RT, EMV, and FF can quantitatively assess the activity and severity of GO and can potentially provide a basis for clinical judgment and selection of treatment options.Evidence Level4.Technical EfficacyStage 2.

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Proptosis in Dysthyroid Ophthalmopathy: A Case Series of 10,931 Japanese Cases

Abstract: This study assessed the measurable features of proptosis in Japanese patients with DO and contributes to the understanding by correlating symptoms and signs of DO.

Cited by 28 publications

References 16 publications

Graves' Ophthalmopathy: Epidemiology and Natural History

Graves' Ophthalmopathy: Epidemiology and Natural History

Clinical Ocular Features in Children and Young Adults with Thyroid Diseases

Application of Multiparameter Quantitative Magnetic Resonance Imaging in the Evaluation of Graves' Ophthalmopathy

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