The relationship between sex and symmetry in thyroid eye disease

Abstract

PurposeTo examine the relationships between sex and symmetry in the context of disease activity, severity, and thyroid status in thyroid eye disease.MethodsRetrospective chart review of 31 men and 31 women with untreated thyroid eye disease. Subjective complaints, smoking status, thyroid status, and objective findings pertinent to the clinical activity score (CAS) and “NO SPECS” classification were recorded. Overall disease asymmetry was defined as having simultaneous asymmetry of both more than one symptom and more than one external finding. Asymmetry was compared across sex and thyroid status. CAS and NO SPECS severity were compared across sex, symmetry, and thyroid status.ResultsAsymmetric appearance was reported by 58% of men and 19% of women. Asymmetric proptosis (>2 mm difference) was seen in 45% of men and 23% of women (P=0.036). Overall asymmetry was seen in 55% of men and 19% of women (P=0.017). Thyroid status and sex had a combined effect on symmetry, as 15 of 16 hyperthyroid females (94%) demonstrated symmetric disease. Average NO SPECS severity was 3.5 (standard deviation [SD] 1.4) in men and 3.3 (SD 1.1) in women (P=0.51), and was 3.8 (SD 1.4) in asymmetric patients versus 3.2 (SD 1.3) in symmetric patients (P=0.08). The CAS was higher in asymmetric than symmetric patients (1.84 versus 0.97; P=0.012).ConclusionMen demonstrated more asymmetric disease (proptosis and overall asymmetry) than women, while hyperthyroid females demonstrated more symmetry than euthyroid and hypothyroid males and females. NO SPECS severity score was unaffected by sex, thyroid status, or symmetry. Asymmetric patients demonstrated higher clinical activity scores.

Asymmetry indicates more severe and active disease in Graves’ orbitopathy: results from a prospective cross-sectional multicentre study

“…Asymmetry in the anatomy of the bony orbit, optic canal, ophthalmic vessels, length of the globe, and exophthalmometer readings of normal subjects is common [18][19][20], but whether structural variations in the orbits are more pronounced in patients with asymmetric/unilateral GO is unknown. The prevalence of asymmetric disease in our cohort was 30.9% and that of unilateral disease 10.7%, which is comparable to reports in published literature of asymmetric in 9-34% [9,10,12,16,17,22] and unilateral disease in 4.5-14.0% of patients with GO [7][8][9][10][11]. The variations in the above figures between studies are probably due to differences in definitions of asymmetry and unilaterality used, and inter-/intra-observer variation.…”

“…In addition, differences in the phase of the natural history of GO at the time of assessment may also have contributed, as after the passage of time some patients with unilateral disease develop bilateral features [11,17]. An association between asymmetric disease and older age [22,23], more active disease [22], and lower female to male ratio [24], has been previously reported, and our study has confirmed these associations. The clustering of all the above features as well as increased severity around asymmetric GO is a finding that has not been described before.…”

Asymmetric Graves’ Orbitopathy

“…Moreover, previous studies have shown no difference in regards to race ( 13 ) and sex ( 29 ), but more recent data, including our recent multicenter study ( 12 ) and a cohort of 354 Chinese patients ( 36 ), have shown that male sex is associated with asymmetry. In another study, male subjects exhibited asymmetric disease (proptosis and overall asymmetry) three-fold more frequently compared with women, while women with hyperthyroidism demonstrated more symmetry compared with euthyroid and hypothyroid individuals of either sexes ( 23 ). With regards to correlation with older age, we have confirmed previous findings supporting higher prevalence and more severe asymmetry in older and especially men ( 12 , 37 ), in keeping with previously described associations between age and male gender with severity of GO in patients with bilateral disease ( 38 ).…”

“…In the past, asymmetry has been variably defined as difference in proptosis between eyes by ≥2 mm ( 13 ), >2 mm ( 11 , 22 ), or any one of the following criteria: retrobulbar pain or > or =1 grade in soft tissue involvement, and/or of > or =2 mm in exophthalmos, and/or > or =8 degrees in elevation ( 23 ), or repeatable asymmetry with regard to more than one symptom and more than one external or anterior segment finding for a duration of two or more visits at least 1 month apart at any time during the initial or follow-up period ( 23 ). Radiological criteria for asymmetry, such a right-to-left ratio of more than 1.4 in extraocular muscle diameter, as obtained by CT measurements based on normative data, have also been proposed ( 24 ).…”

Eye Conditions in Women

“…Although TED is more common in women, men are 4 times more likely to suffer from severe TED 25 and are also more likely to have asymmetric disease. 24,26 No specific sex-based explanations have been noted for this. In addition, the vast majority of studies have not found sex differences in response to treatment of Graves' disease or rates of remission.…”