Thyroid Orbitopathy

Wang, Yao; Tooley, Andrea A.; Mehta, Viraj; Garrity, James A.; Harrison, Andrew R.; Mettu, Priyatham S

doi:10.1097/iio.0000000000000219

Cited by 32 publications

(3 citation statements)

References 201 publications

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“…Graves’ orbitopathy (GO) is an autoimmune inflammatory complication of Graves’ disease (GD). GO is characterized by the enlargement of the extraocular muscles and increase in fatty or orbit connective tissue volume [ 1 , 2 , 3 ]. GO is the most common extrathyroidal manifestation of GD, appearing in 25–70% of patients with this disease [ 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Anti-IL-6 Receptor Tocilizumab in Refractory Graves’ Orbitopathy: National Multicenter Observational Study of 48 Patients

Sánchez-Bilbao

Martínez-López

Revenga

et al. 2020

JCM

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Graves’ orbitopathy (GO) is the most common extrathyroidal manifestation of Graves’ disease (GD). Our aim was to assess the efficacy and safety of Tocilizumab (TCZ) in GO refractory to conventional therapy. This was an open-label multicenter study of glucocorticoid-resistant GO treated with TCZ. The main outcomes were the best-corrected visual acuity (BVCA), Clinical Activity Score (CAS) and intraocular pressure (IOP). These outcome variables were assessed at baseline, 1st, 3rd, 6th and 12th month after TCZ therapy onset. The severity of GO was assessed according to the European Group on Graves’ Orbitopathy (EUGOGO). We studied 48 (38 women and 10 men) patients (95 eyes); mean age ± standard deviation 51 ± 11.8 years. Before TCZ and besides oral glucocorticoids, they had received IV methylprednisolone (n = 43), or selenium (n = 11). GO disease was moderate (n =29) or severe (n = 19) and dysthyroid optic neuropathy (DON) (n = 7). TCZ was used in monotherapy (n = 45) or combined (n = 3) at a dose of 8 mg/kg IV every four weeks (n = 43) or 162 mg/s.c. every week (n = 5). TCZ yielded a significant improvement in all of the main outcomes at the 1st month that was maintained at one year. Comparing the baseline with data at 1 year all of the variables improved; BCVA (0.78 ± 0.25 vs. 0.9 ± 0.16; p = 0.0001), CAS (4.64 ± 1.5 vs. 1.05 ± 1.27; p = 0.0001) and intraocular pressure (IOP) (19.05 ± 4.1 vs. 16.73 ± 3.4 mmHg; p = 0.007). After a mean follow-up of 16.1 ± 2.1 months, low disease activity (CAS ≤ 3), was achieved in 88 eyes (92.6%) and TCZ was withdrawn in 29 cases due to low disease activity (n = 25) or inefficacy (n = 4). No serious adverse events were observed. In conclusion, TCZ is a useful and safe therapeutic option in refractory GO treatment.

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Section: Introductionmentioning

confidence: 99%

Anti-IL-6 Receptor Tocilizumab in Refractory Graves’ Orbitopathy: National Multicenter Observational Study of 48 Patients

Sánchez-Bilbao

Martínez-López

Revenga

et al. 2020

JCM

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“…They were further directed for strabismus surgery due to the finding of asymmetric enlargement of the extraocular muscles in the context of Graves' disease. In this regard, Wang et al [16] argued that inflammatory changes including myositis and fibrosis are the likely cause of the asymmetric expansion of the extraocular muscles, most often involving the inferior and the medial rectus muscles, resulting in restrictive strabismus.…”

Section: Discussionmentioning

confidence: 99%

Balancing orbital volume reduction and redistribution for a tailored surgical treatment in Graves’ ophthalmopathy

Costan

Ciocan-Pendefunda

Ciofu

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Aim The purpose of this study is to share our experience on the use of different orbital decompression techniques, as well as the principles followed for deciding the most case-appropriate procedure that ensured the most favorable outcomes. Methods We reviewed the Graves’ ophthalmopathy cases operated over the course of 14 years, regarding the presenting signs, the imaging evaluation, the degree of exophthalmos, the type of surgical orbital decompression performed, and the postoperative outcomes. Results All 42 patients identified presented with proptosis, with 92.8% cases of bilateral proptosis. The main addressing concern was functional in 54.8% cases and aesthetic in 45.2% patients. CT was used for the preoperative evaluation in all cases. In total, 81 orbits were operated. The orbital decompression surgery involved only the orbital fat in 7.4% of orbits and associated fat and bone decompression in the other 92.6% of orbits. The postoperative results were favorable in all cases regarding both appearance and function, with minimal postoperative complications. Conclusion The adequate selection of the most suitable procedure based on the characteristics of each case is the prerequisite for a successful surgery. We found that the association of fat and bone decompression of various extents is most permissive in tailoring the degree of decompression to the existing requirements.

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“…Thyroid eye disease was the most common cause of orbital disease in our study which is supported by the previous researchers. 5,6,7 Thyroid eye disease includes eyelid edema, conjunctival chemosis, proptosis, eyelid retraction and optic nerve compression. Therefore, proper detection and management by ophthalmologist as well as the endocrinologist and other related specialties are important to prevent its complications.…”

Section: Discussionmentioning

confidence: 99%

Pattern of Orbital Diseases at a Tertiary Oculoplastic Center

Idris

Yaqoob²,

Khan

et al. 2020

pak J Ophthalmol

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Purpose: To determine the causes and frequency of orbital involvement by systemic disorders and non-ocular trauma at a tertiary Oculoplastic centre. Study Design: Descriptive cross-sectional retrospective study. Ophthalmology unit Place and Duration of Study: Department of Ophthalmology, Lady Reading Hospital Medical teaching Institute, Peshawar from January 2012 and Dec 2016. Methods: A total of 45 patients were included in this study. Patients’ demographics, clinical cause of orbitopathy and time delay between the problem noticed by the patient and presentation were recorded. Orbitopathy included the presence of corneal and conjunctival changes, optic nerve disorders, proptosis, orbital bone changes and soft tissue swelling of eyelids. The data was analyzed using SPSS software (version 22). The frequency (percentage) and mean ± standard deviation were reported for categorical variables. Results: Mean age of the patients was 28.89 ± 22.02 years. There were 26 (57.8%) males 19 (42.2%) females. Commonest disorder was Bacterial Infection in 16 (35.6%) patients followed by Thyroid orbitopathy, which was seen in 14 (31.1%) cases. Other causes included Leukemia, Lymphoma, Retrobulbar Hemorrhage, Neurofibromatosis, Neuroblastoma, Maxillary Osteosarcoma, Teratoma and Fungal Infection. Time delay between presentation of orbital swelling and first noticed by patient was 147.02 ± 155.18 weeks in male while in female the time delay was 148.79 ± 146.47 weeks. Conclusion: The commonest inflammation was due to thyroid, commonest infection was bacterial infection and commonest tumor was leukemia. Imaging and proper workup is important to properly treat any orbital disease. Key Words: Orbit, Ocular trauma, Neuroblastoma, Orbital lymphoma.

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Thyroid Orbitopathy

Cited by 32 publications

References 201 publications

Anti-IL-6 Receptor Tocilizumab in Refractory Graves’ Orbitopathy: National Multicenter Observational Study of 48 Patients

Anti-IL-6 Receptor Tocilizumab in Refractory Graves’ Orbitopathy: National Multicenter Observational Study of 48 Patients

Balancing orbital volume reduction and redistribution for a tailored surgical treatment in Graves’ ophthalmopathy

Pattern of Orbital Diseases at a Tertiary Oculoplastic Center

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