Sight‐threatening Graves’ orbitopathy: Twenty years’ experience of a multidisciplinary thyroid‐eye outpatient clinic

Tramunt, Blandine; Imbert, P; Grunenwald, Solange; Boutault, F; Caron, Philippe

doi:10.1111/cen.13880

“…[ 10 ] Other studies among the Caucasians population reported the incidence of sight-threatening orbitopathy to range from 0.3% to 12.9%. [ 19 23 ] In our study, the mild disease was seen in greater proportion of patients (54.7%) moderate to severe disease was found in 37.7% but patients with sight-threatening disease were significantly lesser (7.5%) than that reported by EUGOGO. Asian studies such as by Lim CS et al .…”

Section: Discussionmentioning

confidence: 38%

Clinical profile of thyroid eye disease and factors predictive of disease severity

Muralidhar

¹

,

Das

²

,

Tiple

³

2020

Indian J Ophthalmol

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Purpose: To describe the clinical features of thyroid eye disease (TED) in patients presenting at a tertiary eye care centre in North India and to identify factors predictive of severe disease. Methods: This observational cross-sectional study involved clinical evaluation of all patients with TED who presented at the oculoplastic clinic based on the ITEDS VISA proforma. Risk factors for the severe disease were assessed using univariate and multivariate logistic regression. Results: A total of 106 patients (50 males, 56 females; mean age 41.30 ± 14.76 years) were identified during the study period, 46.23% hyperthyroid, 33.96% hypothyroid and 19.81% euthyroid. The proportion of the patients with hypothyroid was higher as compared with prior studies and most patients with hypothyroid had the mild disease (63.89%). Orbitopathy symptoms were the presenting feature leading to the diagnosis of systemic thyroid abnormality in 25% of the patients with hypothyroid and 59.18% of the patients with hyperthyroid, respectively ( P < 0.05). Eyelid and orbitopathy signs were more common in the patients with hyperthyroid (51.2% and 87.7%) as compared with hypothyroid where the commonest presenting symptoms were related to dry eye (50.1%). Active disease was seen in 22.6% of the patients. Mild, moderate to severe and sight-threatening disease was seen in 54.7%, 37.7% and 7.5%, respectively. On multivariate analyses, hyperthyroid status and activity was associated with severe disease. Smoking was not associated with activity or severity. Conclusion: There is no significant difference in the gender profile of the patients with TED in this cohort. The patients with hypothyroid have a milder disease compared to the patients with hyperthyroid, and dry eye symptoms are the commonest presenting symptoms in hypothyroid subjects. Hyperthyroidism and activity were associated with severe and sight-threatening disease.

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“…[1][2][3] TED presents with visible signs in half of Graves' disease patients, which can manifest as eyelid retraction to more severe and sight-threatening sequelae. 4,5 Although not completely understood, the pathophysiology of TED has been increasingly linked to sensitised T lymphocytes and autoantibodies directed against antigens common between the orbit and the thyroid. [6][7][8] TED can involve either one eye (unilateral TED), or both eyes (bilateral TED).…”

Section: Introductionmentioning

confidence: 99%

The thyroid eye disease (TED) laterality debate: A comparison of characteristics, presentation, severity, and activity, between unilateral and bilateral thyroid eye disease

Miguel

¹

,

Medalle

²

2022

Clinical Epidemiology and Global Health

0

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Background/objectives: Thyroid eye disease (TED), which can lead to severe sequelae, can involve either one eye or both eyes. The importance of knowing the distinction between laterality rests on the risk that either presentation is associated with a more severe form. It is our aim to investigate differences in patient characteristics and presentations between unilateral and bilateral TED. Methods: Cross-sectional study on clinically diagnosed TED patients from December 2013 to April 2018. Patients' sociodemographic factors, medical history, presentation, severity, and activity between unilateral TED and bilateral TED were compared. Results: 65 patients were included (unilateral TED: n = 40, 61.5%; bilateral TED: n = 25, 38.5%). Unilateral and bilateral TED were not different with regards to age, gender, family history of thyroid disease, comorbidities, and smoking status. There was nearly six times the likelihood of methimazole intake being associated with bilateral TED (odds ratio [OR] = 5.80, p = 0.02). Both groups were similar in almost all general presentation, orbital inflammation signs, and manifestations of lid retraction. The exception being blurred vision that was more common among bilateral TED patients (OR = 4.80, p = 0.04). There were also no differences between both groups in terms of thyroid hormones (TSH: p = 0.84; freeT4: p = 0.12), severity (p = 0.61), and activity (p = 0.99). Conclusions: Our study found unilateral TED to be more prevalent, while ongoing methimazole treatment and blurred vision are associated with bilateral TED. Our findings add to the growing evidence suggesting that the laterality of TED is not a factor in differentiating levels of activity or severity.

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“…TED occurs in 35% ( 2 ) of patients with Graves' disease and may affect the patient's appearance, causing ocular discomfort and leading to dysthyroid optic neuropathy (DON). DON, a severe complication of TED, has been demonstrated to occur in 4–8% ( 3 – 5 ) of the population with TED and may lead to a decrease in color vision, visual field defect, and even visual loss without early and prompt management ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

“…The European Group on Graves' Orbitopathy (EUGOGO) classified TED into mild, moderate to severe, and sight-threatening according to the degree of lid retraction, soft tissue involvement, proptosis, and diplopia ( 7 ). Visual field changes, relative afferent pupillary defects, diminished color vision, and radiological hypertrophy of the extraocular muscle might also indicate progression of the disease ( 6 , 8 ). However, as far as we are aware of, none of the aforementioned parameters can be used to objectively quantify the severity of the disease individually.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Microcirculation in Optic Nerve Head Using Laser Speckle Flowgraphy in Active Thyroid Eye Disease

Ho

¹

,

Tsai

²

,

Chu

³

et al. 2022

BioMed Research International

0

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Background. Laser speckle flowgraphy (LSFG) can be used to estimate optic nerve blood flow. This study used LSFG to evaluate optic nerve microcirculation in patients with thyroid eye disease (TED). Methods. This was a retrospective review of patients with active TED who underwent LSFG between October 2020 and June 2021. The mean blur rate (MBR) for different severities of active TED was analyzed by one-way analysis of variance (ANOVA). Results. A total of 30 patients (60 eyes) with a diagnosis of active TED who underwent LSFG were included. The mean age was 49 (range, 33–74) years. Mean best-corrected visual acuity was the worst in the group with sight-threatening active TED ( 0.29 ± 0.33 logarithm of the minimum angle of resolution, p = 0.01 ). The MBR-overall was the highest in the group with mild active TED ( 28.5 ± 2.7 ), followed by that in the moderate to severe ( 23.6 ± 3.2 ), and in the sight-threatening ( 20.2 ± 4.3 ) active TED groups ( p < 0.001 ). The MBR-vessel was 57.1, 47.0, and 39.3 in the mild, moderate to severe, and sight-threatening active TED groups, respectively ( p < 0.001 ). The MBR-tissue was 16.9, 14.4, and 12.0 in the mild, moderate to severe, and sight-threatening active TED groups, respectively ( p < 0.001 ). Conclusions. This study demonstrates that optic nerve blood flow is lower with more severe active TED. In addition, LSFG is an effective, objective, and noninvasive method for evaluating the severity of TED.

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Sight‐threatening Graves’ orbitopathy: Twenty years’ experience of a multidisciplinary thyroid‐eye outpatient clinic

Cited by 27 publications

References 20 publications

Clinical profile of thyroid eye disease and factors predictive of disease severity

Clinical profile of thyroid eye disease and factors predictive of disease severity

The thyroid eye disease (TED) laterality debate: A comparison of characteristics, presentation, severity, and activity, between unilateral and bilateral thyroid eye disease

Evaluation of Microcirculation in Optic Nerve Head Using Laser Speckle Flowgraphy in Active Thyroid Eye Disease

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