Role of Thyroxine in the Development of Keratoconus

Thanos, Solon; Oellers, Patrick; Hörste, Melissa Meyer zu; Prokosch, Verena; Schlatt, Stefan; Seitz, Berthold; Gatzioufas, Zisis

doi:10.1097/ico.0000000000000988

Cited by 56 publications

(44 citation statements)

References 21 publications

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“…Moreover, the tear thyroxine levels of patients with keratoconus were found to be 2 to 50 times higher than those of patients without ocular diseases and levels were higher during the progression of keratoconus and declined once cornea curvature fulfilled a new steady value. Furthermore, a study by Thanos et al 17 showed that thyroid gland dysfunction prevalence among patients with keratoconus was 13.6%. Additionally, other studies by Tabibian et al 18 and Gatzioufas and Thanos 19 support our study results.…”

Section: Discussionmentioning

confidence: 99%

Association Between Keratoconus and Thyroid Gland Dysfunction: A Cross-Sectional Case–Control Study

Elmassry¹,

Doheim²,

Iqbal³

et al. 2020

J Refract Surg

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K eratoconus is a corneal ectatic disorder that starts at puberty and decreases the radius of curvature of the central cornea. 1 Kennedy et al. 2 reported that the incidence rate is 1 per 50,000 among the population. Moreover, the pathophysiological processes underlying keratoconus have not been fully explained and proposed mechanisms including oxidative dam-age, proteolytic degradation in the corneal stroma, epithelial mechanical injury, immunological factors, and genetic factors have been suggested. [1][2][3][4] reported an incidence of keratoconus in 3.5% to 8% of patients with Down syndrome. Furthermore, hormonal imbalances affect the corneal metabolism and may be associated with keratoconus. Likewise, thyroid gland ABSTRACT PURPOSE: To examine the clinical association between thyroid gland dysfunction and keratoconus. METHODS:This was a cross-sectional case-control study conducted between May 2018 and July 2019. After performing Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany) examination, flat, steep, and maximum simulated keratometric readings were recorded for each patient. Serum concentrations of free triiodothyronine, free thyroxine, and thyroidstimulating hormone were measured. Further examinations by an endocrinologist were indicated for patients with positive laboratory results to confirm thyroid gland dysfunction. RESULTS:One hundred eighty-seven patients with bilateral keratoconus and 187 sex-and age-matched healthy controls without keratoconus were analyzed. Mean age was 26.4 ± 8.2 years for the patients with keratoconus and 27.1 ± 9.4 years for the control patients, with no significant difference. The results showed that thyroid gland dysfunction prevalence was 10 of 187 patients with keratoconus (5.3%) and 2 of 187 control patients (1.1%), and the difference was statistically significant (P = .036). For the patients with keratoconus and thyroid gland dysfunction, 8 were women and 2 were men. Additionally, 6 patients (2 men and 4 women) had hyperthyrosis and 4 women had hypothyrosis. For controls, the two patients had hypothyrosis. CONCLUSIONS:This study showed that there is a possible association between keratoconus and thyroid gland dysfunction, but more studies are needed to build upon these results.[J Refract Surg. 2020;36(4):253-257.] (AT). © 2020 El-Massry, Doheim, Iqbal, et al.; licensee SLACK Incorporated. This is an Open Access article distributed under the terms of the Creative Commons . This license allows users to copy and distribute, to remix, transform, and build upon the article non-commercially, provided the author is attributed and the new work is non-commercial.

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Section: Discussionmentioning

confidence: 99%

Association Between Keratoconus and Thyroid Gland Dysfunction: A Cross-Sectional Case–Control Study

Elmassry¹,

Doheim²,

Iqbal³

et al. 2020

J Refract Surg

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“…Seven hundred and twelve eyes from the database of our HKC were included in this study. The aims of the HKC include research in diagnostics, longitudinal course of keratoconus, therapy options and influencing factors, such as the effect of thyroid gland function on keratoconus (Gatzioufas & Thanos 2008;Gatzioufas et al 2014;Thanos et al 2016) and have been described in detail previously (Goebels et al 2013(Goebels et al , 2015. In the HKC, patients from the outpatient service with unilateral or bilateral keratoconus were included, as well as patients with possible corneal abnormality and patients without noticeable ocular abnormality but with thyroid diseases.…”

Section: Patientsmentioning

confidence: 99%

Endothelial alterations in 712 keratoconus patients

Goebels

Eppig

Seitz

et al. 2017

Acta Ophthalmologica

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“…Thanos and co-authors also found higher levels of tear thyroxine in KCs, as well as high expression of thyroxine receptors in the KC stromal cells, when compared to healthy controls [2]. While very limited literature exists on thyroxine and KC, it is known to play a role in metabolism and physiological function of the cornea as well as other tissues [2]. Furthermore, in a recent case study, published by Lee et al [38], a 17-year-old girl underwent partial thyroidectomy without thyroid hormone replacement therapy with a normal baseline ophthalmic exam.…”

Section: Discussionmentioning

confidence: 86%

“…Thyroxine levels in blood (serum) of these patients, however, showed no significant changes. Thanos and co-authors also found higher levels of tear thyroxine in KCs, as well as high expression of thyroxine receptors in the KC stromal cells, when compared to healthy controls [2]. While very limited literature exists on thyroxine and KC, it is known to play a role in metabolism and physiological function of the cornea as well as other tissues [2].…”

Section: Discussionmentioning

confidence: 99%

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Gonadotropins in Keratoconus: The Unexpected Suspects

Karamichos

Barrientez

Nicholas

et al. 2019

Cells

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Keratoconus (KC) is the most common ectatic corneal disease with a significant visual acuity burden. The actual burden is intangible given that KC can disrupt daily activities (reading, driving, and various career paths). Despite decades of research and clinical studies, the etiology, onset, and pathobiology of KC remain a mystery. The purpose of this study was to investigate the role of gonadotropins in KC. We recruited 86 KC patients (63 males, 23 female), and 45 healthy controls (22 male, 23 female). Plasma samples were collected and analyzed using an enzyme-linked immunosorbent assay. Corneal stromal cells from KC and healthy controls, and human epithelial corneal cells, were also investigated for gonadotropin-related markers. Our results show significant alterations of LH/FSH in KCs, compared to healthy controls. Our data also reveals, for the first time, the existence of gonadotropins and their receptors in KC. Our study is the first to demonstrate the role of LH/FSH in KCs, and expand the list of organs known to express gonadotropins, or their receptors, to include the human cornea. Our findings suggest that the human cornea is capable of responding to gonadotropins, and propose an intriguing mechanism for the onset and/or progression of KC.

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Role of Thyroxine in the Development of Keratoconus

Abstract: Our data implicate a crucial role of T4 in KC pathophysiology, which is most likely mediated by T4Rs.

Cited by 56 publications

References 21 publications

Association Between Keratoconus and Thyroid Gland Dysfunction: A Cross-Sectional Case–Control Study

Association Between Keratoconus and Thyroid Gland Dysfunction: A Cross-Sectional Case–Control Study

Endothelial alterations in 712 keratoconus patients

Gonadotropins in Keratoconus: The Unexpected Suspects

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