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Kim M, Lee J, Hwang YB, Kang J, Ahn HY, Lee JK. Graves' orbitopathy development in thyroid cancer patients: a 16-year nationwide cohort study in South Korea. Eye (Lond) 2024:10.1038/s41433-024-03197-9. [PMID: 38942911 DOI: 10.1038/s41433-024-03197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 05/16/2024] [Accepted: 06/20/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND/OBJECTIVES We aimed to investigate the prevalence, risk factors, and prognosis of Graves' orbitopathy (GO) in patients with thyroid cancer without a history of hyperthyroidism. SUBJECTS/METHODS This retrospective cohort study analysed a sample from the Korean National Health Insurance Service database, which included 1,137,861 subjects from 2002 through 2019. Patients diagnosed with thyroid cancer, without a history of hyperthyroidism, were identified according to the Korean Standard Classification of Disease codes. The study compared the type of surgery, dose of radioactive iodine (RAI), and daily average thyroid hormone dose between patients who developed GO after being diagnosed with thyroid cancer and those who did not develop GO. We analysed the course of GO and the type of treatment. RESULTS A total of 8499 cancer patients without a history of hyperthyroidism were identified, among whom 7836 underwent thyroidectomy. Of those who underwent thyroidectomy, 12 developed GO postoperatively. Among the 663 patients who did not undergo thyroidectomy, none developed GO. The prevalence of GO among thyroid cancer patients was 0.14%. The GO group received a significantly higher total RAI dose than the non-GO group (p = 0.036). There were no significant differences in sex, age, type of surgery, rate of RAI treatment, or average thyroid hormone dose between the two groups. One of the 12 patients who developed GO required intravenous steroids. CONCLUSIONS Although GO rarely develops in thyroid cancer patients without coexisting hyperthyroidism, the total RAI dose may increase its risk. Further research would help clarify GO's association with thyroid cancer.
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Affiliation(s)
- Minjeong Kim
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jooyoung Lee
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Yu Been Hwang
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Jinmo Kang
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
| | - Jeong Kyu Lee
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
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Qi CX, Wen Z, Huang X. Altered functional connectivity strength of primary visual cortex in subjects with thyroid-associated ophthalmopathy. Neuroreport 2024; 35:568-576. [PMID: 38652513 DOI: 10.1097/wnr.0000000000002039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Our objective was to explore the disparities in the intrinsic functional connectivity (FC) patterns of primary visual cortex (V1) between patients with thyroid-associated ophthalmopathy (TAO) and healthy controls (HCs) utilizing resting-state functional MRI. Twenty-one patients with TAO (14 males and 7 females; mean age: 54.17 ± 4.83 years) and 21 well-matched HCs (14 males and 7 females; mean age: 55.17 ± 5.37 years) underwent functional MRI scans in the resting-state. We assessed modifications in the intrinsic FC patterns of the V1 in TAO patients using the FC method. Subsequently, the identified alterations in FC regions in the analysis were selected as classification features to distinguish TAO patients from HCs through the support vector machine (SVM) method. The results indicated that, in comparison to HCs, patients with TAO exhibited notably reduced FC values between the left V1 and the bilateral calcarine (CAL), lingual gyrus (LING) and superior occipital gyrus, as well as between the right V1 and the bilateral CAL/LING and the right cerebellum. Furthermore, the SVM classification model based on FC maps demonstrated effective performance in distinguishing TAO patients from HCs, achieving an accuracy of 61.9% using the FC of the left V1 and 64.29% using the FC of the right V1. Our study revealed that patients with TAO manifested disruptions in FC between the V1 and higher visual regions during rest. This might indicate that TAO patients could present with impaired top-down modulations, visual imagery and vision-motor function. These insights could be valuable in understanding the underlying neurobiological mechanisms of vision impairment in individuals with TAO.
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Affiliation(s)
- Chen-Xing Qi
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University
| | - Zhi Wen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan
| | - Xin Huang
- Department of Ophthalmology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Jiang M, Zhang H, Liu Y, Song X, Song Y, Sun J, Tang Y, Zhu L, Zhou H, Li Y, Tao X. White Matter Alterations of Visual Pathway in Thyroid Eye Disease: A Fixel-Based Analysis. J Magn Reson Imaging 2024. [PMID: 38682584 DOI: 10.1002/jmri.29387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Thyroid eye disease (TED), particularly its sight-threatening complication, dysthyroid optic neuropathy (DON), profoundly impacts patients' visual health. The pathological changes in the white matter (WM) fibers within the intracranial visual pathway in TED have been infrequently studied. Understanding these changes holds crucial importance for exploring the pathogenesis and prognosis of TED. PURPOSE To utilize fixel-based analysis (FBA) to clarify the type of microstructural damage occurring in the visual pathway in TED. STUDY TYPE Prospective. SUBJECTS 28 TED with DON patients (11 males and 17 females), 28 TED without DON (non-DON) patients (12 males and 16 females), and 28 healthy controls (HCs) (12 males and 16 females). FIELD STRENGTH/SEQUENCE 3 T; multishell diffusion MRI using echo planar imaging. ASSESSMENT Fiber density (FD) and fiber-bundle cross-section (FC) were calculated to characterize WM microstructural alteration in TED visual pathway. The correlations between FBA metrics and visual field index and mean deviation were examined. STATISTICAL TESTS One-way analysis of variance, Kruskal-Wallis, t-tests, Mann-Whitney U, Chi-square, and Pearson correlation, were conducted with false discovery rate and family wise error corrections. Significance was set at P < 0.05. RESULTS Both DON and non-DON groups showed significant FD loss in the right optic tract compared with HCs, with DON patients experiencing more severe FD loss. Only DON patients had FD loss in the right optic radiation (OR) compared with the non-DON patients and HCs, with no FC difference across groups. FD in DON patients' ORs significantly correlated with visual field index (r = 0.857) and mean deviation (r = 0.751). DATA CONCLUSION Both DON and non-DON affect the WM microstructure of the visual pathway to varying extents. Visual field metrics can reflect the severity of FD damage to the OR in the visual pathway of DON patients. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 3.
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Affiliation(s)
- Mengda Jiang
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyang Zhang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yuting Liu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xuefei Song
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yang Song
- Department of MR Scientific Marketing, Siemens Healthcare, Shanghai, China
| | - Jing Sun
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yan Tang
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Zhu
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huifang Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yinwei Li
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xiaofeng Tao
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Norman O, Vornanen T, Franssila H, Liinamaa J, Karvonen E, Kotkavaara T, Pohjanen VM, Ylikärppä R, Pihlajaniemi T, Hurskainen M, Heikkinen A. Expression of Collagen XIII in Tissues of the Thyroid and Orbit With Relevance to Thyroid-Associated Ophthalmopathy. Invest Ophthalmol Vis Sci 2024; 65:6. [PMID: 38564194 PMCID: PMC10996972 DOI: 10.1167/iovs.65.4.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Antibodies against collagen XIII have previously been identified in patients with active thyroid-associated ophthalmopathy (TAO). Although collagen XIII expression has been described in extraocular muscles and orbital fat, its detailed localization in extraocular and thyroid tissues and the connection to autoimmunity for collagen XIII remain unclear. Our objective was to map the potential targets for these antibodies in the tissues of the orbit and thyroid. Methods We evaluated the expression of collagen XIII in human patient and mouse orbital and thyroid tissues with immunostainings and RT-qPCR using Col13a1-/- mice as negative controls. COL13A1 expression in Graves' disease and goiter thyroid samples was compared with TGF-β1 and TNF, and these were also studied in human thyroid epithelial cells and fibroblasts. Results Collagen XIII expression was found in the neuromuscular and myotendinous junctions of extraocular muscles, blood vessels of orbital connective tissue and fat and the thyroid, and in the thyroid epithelium. Thyroid expression was also seen in germinal centers in Graves' disease and in neoplastic epithelium. The expression of COL13A1 in goiter samples correlated with levels of TGF-B1. Upregulation of COL13A1 was reproduced in thyroid epithelial cells treated with TGF-β1. Conclusions We mapped the expression of collagen XIII to various locations in the orbit, demonstrated its expression in the pathologies of the Graves' disease thyroid and confirmed the relationship between collagen XIII and TGF-β1. Altogether, these data add to our understanding of the targets of anti-collagen XIII autoantibodies in TAO.
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Affiliation(s)
- Oula Norman
- ECM-Hypoxia Research Unit, Faculty of Biochemistry and Molecular Medicine, University of Oulu, Oulu, Finland
| | - Tuuli Vornanen
- Department of General Surgery, Oulu University Hospital, and Medical Research Centre, University of Oulu, and Oulu University Hospital, Oulu, Finland
| | - Hanna Franssila
- Department of General Surgery, Oulu University Hospital, and Medical Research Centre, University of Oulu, and Oulu University Hospital, Oulu, Finland
| | - Johanna Liinamaa
- Department of Ophthalmology, Oulu University Hospital, and Research Unit of Clinical Medicine, Medical Research Centre, University of Oulu, and Oulu University Hospital, Oulu, Finland
| | - Elina Karvonen
- Department of Ophthalmology, Oulu University Hospital, and Research Unit of Clinical Medicine, Medical Research Centre, University of Oulu, and Oulu University Hospital, Oulu, Finland
| | - Tommi Kotkavaara
- Department of Ophthalmology, Oulu University Hospital, and Research Unit of Clinical Medicine, Medical Research Centre, University of Oulu, and Oulu University Hospital, Oulu, Finland
| | - Vesa-Matti Pohjanen
- Cancer and Translational Medicine Research Unit, Medical Research Centre Oulu, University of Oulu, and Oulu University Hospital, Oulu, Finland
| | - Ritva Ylikärppä
- Department of General Surgery, Oulu University Hospital, and Medical Research Centre, University of Oulu, and Oulu University Hospital, Oulu, Finland
| | - Taina Pihlajaniemi
- ECM-Hypoxia Research Unit, Faculty of Biochemistry and Molecular Medicine, University of Oulu, Oulu, Finland
| | - Merja Hurskainen
- Department of Ophthalmology, Oulu University Hospital, and Research Unit of Clinical Medicine, Medical Research Centre, University of Oulu, and Oulu University Hospital, Oulu, Finland
| | - Anne Heikkinen
- ECM-Hypoxia Research Unit, Faculty of Biochemistry and Molecular Medicine, University of Oulu, Oulu, Finland
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Roda M, Valsecchi N, di Geronimo N, Repaci A, Vicennati V, Pagotto U, Fresina M, Fontana L, Schiavi C. Long-term surgical outcome and impact on daily life activities of strabismus surgery in thyroid-associated ophthalmopathy with and without previous orbital decompression. Head Face Med 2024; 20:22. [PMID: 38561852 PMCID: PMC10983756 DOI: 10.1186/s13005-024-00423-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUNDS To report the long-term surgical outcomes and the impact on daily life activities of strabismus surgery in patients with Thyroid Associated Orbitopathy (TAO) with and without previous orbital decompression. METHODS Patients who underwent strabismus surgery for TAO were retrospectively reviewed. The primary outcome was to evaluate the influence of orbital decompression on the outcomes of TAO related strabismus surgery. Surgical success was defined by the resolution of diplopia and a post-operative deviation < 10 prism diopters (PD). The secondary outcomes were the clinical features, surgical approaches, and impact on daily life activities. RESULTS A total of 45 patients were included in the study. The decompression surgery group (DS) included 21 patients (46.7%), whereas the non-decompression surgery group (NDS) patients were 24 (53.3%). The mean follow-up time from the last strabismus surgery was 2,8 years (range 8-200 months). Successful surgical outcome was achieved in 57,1% of patients in the DS, and 75% of patients in the NDS (p = 0,226). DS patients required almost twice the number of surgical interventions for strabismus compared to the NDS (1,95 vs. 1,16 respectively, p = 0,006), a higher number of extraocular muscles recessed in the first surgery (2,67 vs. 1,08 respectively, p < 0.001), and a lower rate of unidirectional surgery compared to NDS (23% vs. 95%, p < 0,001). At the pre-operative assessment, 71.4% of DS patients had eso-hypotropia, while no patients had this type of strabismus in the NDS group (p < 0.001). On the other hand, the hypotropia rate was 79.2% in NDS patients and only 4.8% in DS patients (p < 0.001). Moreover, 21,8% of NDS patients used prism lenses in daily life activities, compared to 42.9% of patients that used prism lenses to reduce the impairment in their daily life activities (p = 0.016). CONCLUSIONS The results of our study showed that DS patients required almost twice the number of strabismus surgical procedures, a higher number of extraocular muscles recessed in the first surgery, and an increased need for prism lenses to correct the residual deviation compared to the NDS, but with similar long-term surgical outcomes.
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Affiliation(s)
- Matilde Roda
- Ophthalmology Unit, DIMEC, University of Bologna, Via Pelagio Palagi 9, 4038, Bologna, Italy.
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Nicola Valsecchi
- Ophthalmology Unit, DIMEC, University of Bologna, Via Pelagio Palagi 9, 4038, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Natalie di Geronimo
- Ophthalmology Unit, DIMEC, University of Bologna, Via Pelagio Palagi 9, 4038, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Repaci
- Endocrinology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Valentina Vicennati
- Endocrinology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Uberto Pagotto
- Endocrinology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Michela Fresina
- Ophthalmology Unit, DIMEC, University of Bologna, Via Pelagio Palagi 9, 4038, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Fontana
- Ophthalmology Unit, DIMEC, University of Bologna, Via Pelagio Palagi 9, 4038, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Costantino Schiavi
- Ophthalmology Unit, DIMEC, University of Bologna, Via Pelagio Palagi 9, 4038, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Rosenblatt TR, Chiou CA, Yoon MK, Wolkow N, Lee NG, Freitag SK. Proptosis Regression After Teprotumumab Treatment for Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2024; 40:187-191. [PMID: 37791840 DOI: 10.1097/iop.0000000000002531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
PURPOSE This study analyzed the degree and timing of proptosis regression after teprotumumab therapy. METHODS A retrospective study of all patients who completed 8 teprotumumab infusions at 1 institution from January 1, 2020 to December 31, 2022. Change in proptosis was assessed in millimeters and percentages compared with immediate post-treatment and pretreatment proptosis. RESULTS Of 119 patients with post-treatment data (mean follow-up 10.56 months, range: 3.05-25.08), 208 (87.39%) eyes of 110 patients had initial proptosis improvement. Of the 78 patients with multiple follow-up visits, 102 (65.38%) eyes of 59 patients had proptosis regression averaging 12.78% (range: 1.85-58.82%) compared with immediately post-treatment or 2.43 mm (0.5-10.0 mm). Eight (7.84%) eyes had initial documentation of regression more than 1 year after treatment, 40 (39.22%) between 6 months and 1 year, and 54 (52.94%) eyes within 6 months with 25 (46.30%) of these continuing to worsen at subsequent follow-up. Forty (25.64%) eyes of 24 patients had more proptosis at most recent follow-up than before teprotumumab, with an average regression of 1.53 mm (0.5-4.0 mm) or 7.74% (1.85-20.69%) of pretreatment proptosis. In comparison, 99 (63.46%) eyes of 54 patients maintained improvement, with reduction averaging 3.13 mm (0.5-11.0 mm) or 13.19% (1.92-41.67%) of pretreatment proptosis ( p < 0.001). CONCLUSIONS Two-thirds of eyes had regression despite initial teprotumumab response, typically within 1 year of treatment, with ongoing worsening over time. Most patients maintained some proptosis reduction compared with before treatment despite regression, although 25% were worse than pretreatment. The occurrence of regression was independent of the pretreatment duration of clinical thyroid eye disease. Overall, compared with preteprotumumab, there was a greater amount of improvement than regression at most recent follow-up.
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Affiliation(s)
- Tatiana R Rosenblatt
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
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Radulovich N, Van Brummen A, Chambers C, Zhang M. Successful Case of Teprotumumab Treatment in an Adolescent Patient With Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2024; 40:e65-e67. [PMID: 38231594 DOI: 10.1097/iop.0000000000002588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
A 16-year-old black female presented with a 4-month history of significant proptosis and diplopia in the setting of diagnosed Graves disease. The patient underwent 8 infusions of teprotumumab. She had migraines and diplopia that were resolved with treatment. There was also a dramatic improvement in her proptosis. The authors present the first reported case of successful teprotumumab treatment in an adolescent patient, describing outcomes and proposing a mechanism for her transient side effects.
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Affiliation(s)
- Nicholas Radulovich
- Department of Ophthalmology, University of Washington, Seattle, Washington, U.S.A
- Elson S. Floyd College of Medicine, Washington State University, Everett, Washington, U.S.A
| | | | - Christopher Chambers
- Department of Ophthalmology, University of Washington, Seattle, Washington, U.S.A
| | - Matthew Zhang
- Department of Ophthalmology, University of Washington, Seattle, Washington, U.S.A
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Bartalena L, Gallo D, Tanda ML, Kahaly GJ. Thyroid Eye Disease: Epidemiology, Natural History, and Risk Factors. Ophthalmic Plast Reconstr Surg 2023; 39:S2-S8. [PMID: 38054980 DOI: 10.1097/iop.0000000000002467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Thyroid eye disease (TED) is an autoimmune disorder of the orbit and the most frequent extrathyroidal manifestation of Graves' disease but it may rarely occur in euthyroid/hypothyroid patients with chronic autoimmune thyroiditis. EPIDEMIOLOGY TED is a relatively infrequent disorder, particularly in its severe forms. Men tend to have more severe TED at an older age. The prevalence of TED is lower than in the past among patients with recent onset Graves' hyperthyroidism, and moderate-to-severe forms requiring aggressive treatments are no more than 5% to 6% of all cases. NATURAL HISTORY After an initial inflammatory (active) phase and a plateau phase, TED stabilizes and eventually inactivates (inactive or burnt-out phase) after an estimated period of 18-24 months. Minimal-to-mild TED often remits spontaneously, but complete restitutio ad integrum almost never occurs when TED is more than mild. RISK FACTORS Several risk factors contribute to its development on a yet undefined genetic background. Cigarette smoking is the most important of them, but thyroid dysfunction (both hyper- and hypothyroidism), radioactive iodine therapy (if not accompanied by low-dose steroid prophylaxis), elevated thyrotropin receptor antibodies, and, probably, hypercholesterolemia represent relevant modifiable risk factors. Early diagnosis, control and removal of modifiable risk factors, and early treatment of mild forms of GO (local treatment and selenium) may effectively limit the risk of progression to more severe forms.
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Affiliation(s)
| | - Daniela Gallo
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maria Laura Tanda
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - George J Kahaly
- Department of Medicine I, Johannes Gutenberg University, Mainz, Germany
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Potvin ARGG, Pakdel F, Saeed P. Dysthyroid Optic Neuropathy. Ophthalmic Plast Reconstr Surg 2023; 39:S65-S80. [PMID: 38054987 DOI: 10.1097/iop.0000000000002555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE Dysthyroid optic neuropathy (DON) is a sight-threatening complication of thyroid eye disease (TED). This review provides an overview of the epidemiology, pathogenesis, diagnosis, and current therapeutic options for DON. METHODS A literature review. RESULTS DON occurs in about 5% to 8% of TED patients. Compression of the optic nerve at the apex is the most widely accepted pathogenic mechanism. Excessive stretching of the nerve might play a role in a minority of cases. Increasing age, male gender, smoking, and diabetes mellitus have been identified as risk factors. Diagnosis of DON is based on a combination of ≥2 clinical findings, including decreased visual acuity, decreased color vision, relative afferent pupillary defect, visual field defects, or optic disc edema. Orbital imaging supports the diagnosis by confirming apical crowding or optic nerve stretching. DON should be promptly treated with high-dose intravenous glucocorticoids. Decompression surgery should be performed, but the response is incomplete. Radiotherapy might play a role in the prevention of DON development and may delay or avoid the need for surgery. The advent of new biologic-targeted agents provides an exciting new array of therapeutic options, though more research is needed to clarify the role of these medications in the management of DON. CONCLUSIONS Even with appropriate management, DON can result in irreversible loss of visual function. Prompt diagnosis and management are pivotal and require a multidisciplinary approach. Methylprednisolone infusions still represent first-line therapy, and surgical decompression is performed in cases of treatment failure. Biologics may play a role in the future.
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Affiliation(s)
- Arnaud R G G Potvin
- Orbital Center Amsterdam, Department of Ophthalmology, Amsterdam University Medical Center, location AMC, The Netherlands
| | - Farzad Pakdel
- Department of Oculo-Facial Plastic Surgery, Tehran University of Medical Sciences, Farabi Hospital, Tehran, Iran
| | - Peerooz Saeed
- Orbital Center Amsterdam, Department of Ophthalmology, Amsterdam University Medical Center, location AMC, The Netherlands
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Plotuna IȘ, Balaş M, Golu I, Amzăr D, Cornianu M, Vărcus F, Vlad A, Vlad M. A rare form of hyperthyroidism leading to the diagnosis of acromegaly: A case report. Exp Ther Med 2023; 26:477. [PMID: 37664685 PMCID: PMC10469149 DOI: 10.3892/etm.2023.12176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Acromegaly is a rare disease, usually caused by a pituitary tumor. It typically exhibits slow evolution and can result in numerous complications. In the present case report, the patient presented with hyperthyroidism associated with ophthalmopathy and right nodular goiter. The laboratory tests revealed persistent high levels of phosphorus without an apparent cause. After ruling out common pathologies associated with this finding, a focus was placed on the clinical aspects associated with acromegaly, a rare cause of hyperphosphatemia. Laboratory tests and MRI confirmed the diagnosis. The patient underwent transsphenoidal surgery, but the disease remained active, thus medical treatment was initiated, to a poor initial response. Associated with acromegaly, two distinct thyroid pathologies were diagnosed: Toxic adenoma and Graves' disease. This case highlights the challenges in diagnosing and managing a rare endocrine pathology.
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Affiliation(s)
- Iulia-Ștefania Plotuna
- Second Department of Internal Medicine, Discipline of Endocrinology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Endocrinology, ‘Pius Brinzeu’ Emergency County Hospital, 300736 Timisoara, Romania
- Molecular Research Center in Nephrology and Vascular Pathology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Melania Balaş
- Second Department of Internal Medicine, Discipline of Endocrinology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Endocrinology, ‘Pius Brinzeu’ Emergency County Hospital, 300736 Timisoara, Romania
- Molecular Research Center in Nephrology and Vascular Pathology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioana Golu
- Second Department of Internal Medicine, Discipline of Endocrinology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Endocrinology, ‘Pius Brinzeu’ Emergency County Hospital, 300736 Timisoara, Romania
- Molecular Research Center in Nephrology and Vascular Pathology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Daniela Amzăr
- Second Department of Internal Medicine, Discipline of Endocrinology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Endocrinology, ‘Pius Brinzeu’ Emergency County Hospital, 300736 Timisoara, Romania
- Molecular Research Center in Nephrology and Vascular Pathology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mărioara Cornianu
- Department of Morphopathology, ‘Pius Brinzeu’ Emergency County Hospital, 300736 Timisoara, Romania
- Discipline of Morphopathology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Flore Vărcus
- Second Surgical Department, ‘Pius Brinzeu’ Emergency County Hospital, 300736 Timisoara, Romania
- Second Surgical Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adrian Vlad
- Molecular Research Center in Nephrology and Vascular Pathology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Diabetes and Metabolic Diseases, ‘Pius Brinzeu’ Emergency County Hospital, 300736 Timisoara, Romania
- Second Department of Internal Medicine, Discipline of Diabetes, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mihaela Vlad
- Second Department of Internal Medicine, Discipline of Endocrinology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Endocrinology, ‘Pius Brinzeu’ Emergency County Hospital, 300736 Timisoara, Romania
- Molecular Research Center in Nephrology and Vascular Pathology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
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11
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Guo J, Ma R, Gan L, Li X, Xue K, Cheng J, Qian J. Changes in retinal nerve fibre layer, ganglion cell layer and visual function in eyes with thyroid eye disease of different severities with and without orbital decompression. Eye (Lond) 2023; 37:1571-1576. [PMID: 35902746 PMCID: PMC10219964 DOI: 10.1038/s41433-022-02142-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/15/2022] [Accepted: 06/10/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate progressive changes in retinal nerve fibre layer (RNFL), ganglion cell layer/inner plexiform layer (GCL/IPL) and visual function in thyroid eye disease (TED) patients with and without orbital decompression. METHODS Sixty TED patients (105 eyes) were included. All patients were divided into mild, moderate-to-severe and dysthyroid optic neuropathy (DON) groups. Orbital decompression was performed in the moderate-to-severe and DON groups. Optic coherence tomography (OCT), visual field (VF) and best-corrected visual acuity (BCVA) were performed pre- and postoperatively. Preoperative follow-up was performed in the mild group and in part of the moderate-to-severe and DON groups. RESULTS After decompression, the thickness of GCL/IPL and RNFL significantly decreased in DON group (p < 0.05), with varying degrees of decrease in eyes with optic disc swelling, atrophy and normal appearance. The mean GCL/IPL thickness significantly decreased in moderate-to-severe group (p < 0.05), the mean RNFL thickness slightly decreased with no statistical significance (p = 0.07). During the preoperative follow-ups, the mean GCL/IPL thickness significantly decreased (p = 0.04), whereas the mean RNFL thickness tended to increase (p = 0.13) in DON group. The thickness of GCL/IPL and RNFL did not change significantly in the mild and moderate-to-severe groups (p > 0.05). BCVA and VF did not change significantly in any group (p > 0.05) preoperatively. CONCLUSION Swelling and degeneration of retinal ganglion cells (RGCs) may coexist in DON eyes, leading to continuous changes in the RNFL and GCL/IPL thickness either before or after decompression. Slight swelling and degeneration of RGCs may exist in moderate-to-severe TED eyes, although OCT measurements and visual functions remain stable before surgery.
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Affiliation(s)
- Jie Guo
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Ruiqi Ma
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Lu Gan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaofeng Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Kang Xue
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Jinwei Cheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Jiang Qian
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
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12
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Hu Y, Chen J, Lin K, Yu X. Efficacy and Safety of intravenous monoclonal antibodies in patients with moderate-to-severe active Graves'ophthalmopathy: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1160936. [PMID: 37288301 PMCID: PMC10242093 DOI: 10.3389/fendo.2023.1160936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023] Open
Abstract
Backgrounds The effects of various treatments on Graves' ophthalmopathy (GO) have been studied. As monoclonal antibodies (mAbs) have been proposed for the treatment of moderate to severe GO, direct comparisons between different mAbs are lacking.We therefore conducted this meta-analysis to objectively compare the efficacy and safety of intravenous mAbs. Methods To identify eligible trials, references published before September 2022 were electronically searched in PubMed, Web of Science, Pubmed, Embase,Cochrane Library, CBM, CNKI,Wan-Fang and ICTRP databases.The Newcastle-Ottawa scale (NOS) and the Cochrane Risk of Bias Assessment Tool were used to assess the risk of bias of the original studies.The primary and secondary outcomes were the response and inactivation rates, with the secondary outcomes being the clinical activity score (CAS),the improvement of proptosis and diplopia improvement,and the adverse event rate. Publication bias was evaluated, along with subgroup and sensitivity analyses. Results A total of 12 trials with 448 patients were included. The meta-analysis showed that TCZ (tocilizumab) was most likely to be the best treatment in terms of response according to indirect contrast, followed by TMB (teprotumumab) and RTX (rituximab).TCZ, followed by TMB and RTX, was also most likely to be the best treatment in terms of reducing proptosis. In terms of improving diplopia, TMB was most likely to be the best treatment, followed by TCZ and RTX.TCZ was the highest probability of safety, followed by RTX and TMB. Conclusions Based on the best available evidence,TCZ should be the preferred treatment for moderate to severe GO.In the absence of head-to-head trials,indirect comparisons of treatments are routinely used to estimate the effectiveness of the treatments of interest. In addition,the optimal dose and potential mechanism of action of monoclonal antibodies remain to be established,and it is encouraging that the treatment paradigm for GO may change in the future.This study was designed in accordance with the Preferred Reporting Items for conducting Systematic Reviews and Meta-Analyses (PRISMA)(27). Systematic Review Registration http://www.crd.york.ac.uk/prospero, identifier CRD42023398170.
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Affiliation(s)
- Yu Hu
- Laboratory of Endocrinology and Metabolism/Department of Endocrinology and Metabolism, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Endocrinology and Metabolism, Chengdu First People’s Hospital, Chengdu, China
| | - Jinhua Chen
- Department of General Practice, Chengdu First People’s Hospital, Chengdu, China
| | - Ken Lin
- Department of Endocrinology and Metabolism, Chengdu First People’s Hospital, Chengdu, China
| | - Xijie Yu
- Laboratory of Endocrinology and Metabolism/Department of Endocrinology and Metabolism, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
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13
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Lee S, Yu J, Kim Y, Kim M, Lew H. Application of an Interpretable Machine Learning for Estimating Severity of Graves’ Orbitopathy Based on Initial Finding. J Clin Med 2023; 12:jcm12072640. [PMID: 37048722 PMCID: PMC10095042 DOI: 10.3390/jcm12072640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/15/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
(1) Background: We constructed scores for moderate-to-severe and muscle-predominant types of Graves’ orbitopathy (GO) risk prediction based on initial ophthalmic findings. (2) Methods: 400 patients diagnosed with GO and followed up at both endocrinology and ophthalmology clinics with at least 6 months of follow-up. The Score for Moderate-to-Severe type of GO risk Prediction (SMSGOP) and the Score for Muscle-predominant type of GO risk Prediction (SMGOP) were constructed using the machine learning-based automatic clinical score generation algorithm. (3) Results: 55.3% were classified as mild type and 44.8% were classified as moderate-to-severe type. In the moderate-to-severe type group, 32.3% and 12.5% were classified as fat-predominant and muscle-predominant type, respectively. SMSGOP included age, central diplopia, thyroid stimulating immunoglobulin, modified NOSPECS classification, clinical activity score and ratio of the inferior rectus muscle cross-sectional area to total orbit in initial examination. SMGOP included age, central diplopia, amount of eye deviation, serum FT4 level and the interval between diagnosis of GD and GO in initial examination. Scores ≥46 and ≥49 had predictive value, respectively. (4) Conclusions: This is the first study to analyze factors in initial findings that can predict the severity of GO and to construct scores for risk prediction for Korean. We set the predictive scores using initial findings.
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Affiliation(s)
- Seunghyun Lee
- Department of Ophthalmology, Konyang University, Kim’s Eye Hospital, Myung-Gok Eye Research Institute, Seoul 07301, Republic of Korea
| | - Jaeyong Yu
- Department of Biomedical System Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yuri Kim
- Department of Ophthalmology, Bundang CHA Medical Center, CHA University, Seongnam 13496, Republic of Korea
| | - Myungjin Kim
- Department of Ophthalmology, Bundang CHA Medical Center, CHA University, Seongnam 13496, Republic of Korea
| | - Helen Lew
- Department of Ophthalmology, Bundang CHA Medical Center, CHA University, Seongnam 13496, Republic of Korea
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14
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The Role of Vitamin D in Autoimmune Thyroid Diseases: A Narrative Review. J Clin Med 2023; 12:jcm12041452. [PMID: 36835987 PMCID: PMC9966459 DOI: 10.3390/jcm12041452] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/27/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Vitamin D (VitD) deficiency has garnered significant attention in contemporary medical research. Although the canonical biological activity of VitD manifests itself mainly in the regulation of calcium-phosphorus metabolism, recent studies show that, thanks to the presence of numerous receptors, VitD may also play an important role in regulating the immune system. VitD deficiency has been demonstrated to impact autoimmune disease, coeliac disease, infections (including respiratory/COVID-19), and patients with cancer. Recent studies also show that VitD plays a significant role in autoimmune thyroid diseases (AITDs). Many studies have shown a correlation between low VitD levels and chronic autoimmune thyroiditis - Hashimoto thyroiditis (HT), Graves' disease (GD), and postpartum thyroiditis (PPT). This review article, therefore, describes the current state of knowledge on the role of VitD in AITDs, including HT, GD, and PTT.
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15
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Tu Y, Jin H, Xu M, Liu W, Hu X, Wang M, Ye J, Liu Z, Gao M, Hou F, Lu ZL, Wu W. Reduced contrast sensitivity function correlated with superficial retinal capillary plexus impairment in early stage of dysthyroid optic neuropathy. EYE AND VISION (LONDON, ENGLAND) 2023; 10:11. [PMID: 36737796 PMCID: PMC9898895 DOI: 10.1186/s40662-023-00328-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/08/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND To assess the accuracy of contrast sensitivity function (CSF) in detecting dysthyroid optic neuropathy (DON) at an early stage in thyroid-associated ophthalmopathy (TAO) patients and to examine potential factors that may be linked to early visual impairments in these individuals. METHODS A total of 81 TAO patients (50 non-DON and 31 DON), and 24 control subjects participated in the study. CSF was measured with the quick CSF (qCSF) method. Optical coherence tomography angiography (OCTA) images of the ganglion cell complex layer (GCCL), superficial and deep retinal capillary plexuses (SRCP and DRCP) in a 3 mm diameter area around the macula were evaluated. RESULTS Compared with the controls, the area under the log contrast sensitivity function (AULCSF) and SRCP density were significantly reduced in non-DON and DON patients (all P < 0.05). The GCCL thickness of the DON patients was thinner than that of the controls and non-DON patients (all P < 0.05). The AULCSF was significantly correlated with spherical equivalent refractive error, muscle index, SRCP density and GCCL thickness in TAO patients, respectively (all P < 0.05). However, stepwise multi-regression analysis showed that the AULCSF was only significantly correlated with SRCP density (P < 0.001). Receiver operating characteristic curve analysis showed that the AULCSF produced the most accurate discrimination between non-DON and DON patients from the controls (AUC = 0.831, 0.987, respectively; all P < 0.001). CONCLUSIONS CSF change in the early stage of DON is related to SRCP density. It can be an early indicator of visual impairments associated with DON in TAO patients.
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Affiliation(s)
- Yunhai Tu
- grid.268099.c0000 0001 0348 3990The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027 China
| | - Haochen Jin
- grid.268099.c0000 0001 0348 3990The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027 China
| | - Mingna Xu
- grid.268099.c0000 0001 0348 3990The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027 China
| | - Weijie Liu
- grid.268099.c0000 0001 0348 3990The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027 China
| | - Xiaozhou Hu
- grid.268099.c0000 0001 0348 3990The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027 China
| | - Mengting Wang
- grid.268099.c0000 0001 0348 3990The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027 China
| | - Jie Ye
- grid.268099.c0000 0001 0348 3990The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027 China
| | - Zihui Liu
- grid.268099.c0000 0001 0348 3990The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027 China
| | - Mengyuan Gao
- grid.268099.c0000 0001 0348 3990The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027 China
| | - Fang Hou
- grid.268099.c0000 0001 0348 3990The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027 China
| | - Zhong-Lin Lu
- grid.449457.f0000 0004 5376 0118Division of Arts and Sciences, NYU Shanghai, Shanghai, China ,grid.137628.90000 0004 1936 8753Center for Neural Science and Department of Psychology, New York University, New York, USA ,grid.449457.f0000 0004 5376 0118NYU-ECNU Institute of Brain and Cognitive Science, NYU Shanghai, Shanghai, China
| | - Wencan Wu
- grid.268099.c0000 0001 0348 3990The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027 China ,grid.268099.c0000 0001 0348 3990Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou, 325000 Zhejiang China
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16
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A retrospective study of clinical features and prognosis of patients with Graves' disease and ophthalmopathy. Nucl Med Commun 2023; 44:137-141. [PMID: 36630217 DOI: 10.1097/mnm.0000000000001649] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To retrospectively investigate the clinical characteristics of patients with Graves' disease (GD) accompanied by ophthalmopathy (GO) and the prognosis of single 131I therapy. METHODS In total, 665 patientswith Graves' disease were enrolled in this study, including 115 patients with GO and 550 patients without GO. On the one hand, the clinical characteristics of the two groups were recorded. On the other hand, the prognosis after more than 6 months of 131I therapy was divided into three groups: recovered, hypothyroidism and unhealed. RESULTS Compared with GD-alone patients, GD patients with GO were younger, had a higher thyrotrophin receptor antibody (TRAb), heavier thyroid mass and higher dose of single 131I therapy (all P < 0.05). Furthermore, patients were younger in the clinical active score ≥3 group and had higher FT4 level in the mild GO group (all P < 0.05). Among these, age and TRAb were independent risk factors for GO in GD patients (P < 0.05). When age was <52.5 years and TRAb was >24.01 IU/L, GD patients were more likely to develop GO (P < 0.001). After at least 6 months of single 131I therapy, compared with GD-alone patients, the prognosis was poor in GD patients with GO (P < 0.05). CONCLUSION Young GD patients with heavy thyroid mass and high TRAb are more likely to have GO. Younger GO patients are more likely to be active stage and the level of thyroid function was inversely correlated with the severity of GO. When the age and TRAb have exceeded the cutoff value, we should pay more attention to the occurrence of GO and shorten the follow-up interval appropriately. Patients with GD combined with GO have a poor prognosis.
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17
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Ugradar S, Goldberg RA, Douglas RS. Changing the face of thyroid eye disease. Eye (Lond) 2023; 37:197-199. [PMID: 35882983 PMCID: PMC9873613 DOI: 10.1038/s41433-022-02186-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/20/2022] [Accepted: 07/14/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Shoaib Ugradar
- grid.19006.3e0000 0000 9632 6718The Jules Stein Eye Institute University of California, Los Angeles, CA USA
| | - Robert A. Goldberg
- grid.19006.3e0000 0000 9632 6718The Jules Stein Eye Institute University of California, Los Angeles, CA USA
| | - Raymond S. Douglas
- grid.50956.3f0000 0001 2152 9905Cedars-Sinai Medical Center, Los Angeles, CA USA
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18
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Kandasamy S, Agrawal S, Pushker N, Meel R, Bajaj MS, Thirumurthy V, Jyotsna VP. Correlation of Levator-Muller's Complex Thickness on Ultrasound Biomicroscopy to Botulinum Toxin A Injection in Thyroid-Related Upper Eyelid Retraction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:399-408. [PMID: 35546328 DOI: 10.1002/jum.16004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/21/2022] [Accepted: 05/01/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To study the thickness of levator palpebra superioris-Muller's muscle complex (LMC) on ultrasound biomicroscopy (UBM) and to correlate with the clinical response to botulinum toxin A (BTA) injection in patients with inactive-stage of thyroid-related upper eyelid retraction (UER). We also studied the correlation of clinical parameters, preinjection with postinjection values. METHODS This was a prospective, interventional study. Patients with thyroid-related UER who underwent subconjunctival injection of BTA were recruited. Demographic data and clinical details were evaluated. UBM (50 MHz) was done to measure the thickness of LMC. Patient's satisfaction was graded at each follow-up. Follow-up was done at 1 week, 1 month, and 3 months' time intervals. RESULTS A total of 13 patients were recruited and 26 eyes were divided into two groups; group 1 included eyes with UER (n = 17), and group 2 included eyes without UER (n = 9). There was a statistically significant reduction in margin reflex distance 1 (MRD1) after BTA injection at 1-week, 1-month, and 3-months follow-up with maximum reduction at 1 month. The mean LMC thickness of 26 eyes was 0.96 mm which was found to be significantly more than normal controls. On comparison of mean LMC thickness with the amount of UER and reduction in MRD1, we did not find a significant difference. CONCLUSIONS Patients with TED have significantly thicker LMC on UBM than controls. Further studies are needed with a larger sample size on the correlation of UBM features of levator aponeurosis with response to BTA injection.
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Affiliation(s)
- Sindhuja Kandasamy
- Oculoplastics & Oncology Services, All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Agrawal
- Oculoplastics & Oncology Services, All India Institute of Medical Sciences, New Delhi, India
| | - Neelam Pushker
- Oculoplastics & Oncology Services, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Meel
- Oculoplastics & Oncology Services, All India Institute of Medical Sciences, New Delhi, India
| | - Mandeep S Bajaj
- Oculoplastics & Oncology Services, All India Institute of Medical Sciences, New Delhi, India
| | - Velpandian Thirumurthy
- Department of Ocular Pharmacology, Dr R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P Jyotsna
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
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19
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Sharif MW, Mungara S, Bajaj K, Amador P, Khandelwal N. Orbital Lymphoma Masquerading as Euthyroid Orbitopathy. Cureus 2023; 15:e34885. [PMID: 36925990 PMCID: PMC10011929 DOI: 10.7759/cureus.34885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2023] [Indexed: 02/13/2023] Open
Abstract
Thyroid eye disease (TED), also called Graves orbitopathy (GO), is the most common diagnosis of orbital tissue inflammation. It is typically associated with the onset of hyperthyroidism, an autoimmune response to excess amounts of thyroid hormone. However, a visible and palpable lump, strictly unilateral or gross asymmetric eye involvement, non-axial (eccentric) proptosis, a lack of lid retraction or lid lag on downward gaze, or weakened muscle function (suggestive of tendon involvement) are the key features of non-TED mediated ocular involvement, as was found in the case we report here. Orbital lymphoma should always be suspected and excluded in all cases of orbital inflammation. Our patient was diagnosed with mucosa-associated lymphoid tissue (MALT) lymphoma at 27 years of age, two years after the diagnosis of euthyroid ophthalmopathy. This case highlights the need to include space-occupying lesions in the differential diagnosis of proptosis and gaze restrictions, even in younger patients.
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Affiliation(s)
- Muhammad Waqar Sharif
- Internal Medicine, Texas Tech University Health Science Center at Permian Basin, Odessa, USA
| | - Sai Mungara
- Internal Medicine, Texas Tech University Health Science Center at Permian Basin, Odessa, USA
| | - Kelash Bajaj
- Hematology and Oncology, Texas Tech University Health Science Center at Permian Basin, Odessa, USA
| | - Pablo Amador
- Internal Medicine, Texas Tech University Health Science Center at Permian Basin, Odessa, USA
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20
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Smith TJ, Cockerham K, Lelli G, Choudhary C, Taylor S, Barretto N, Enstone A, Oliver L, Lynch J, Holt RJ. Utility Assessment of Moderate to Severe Thyroid Eye Disease Health States. JAMA Ophthalmol 2023; 141:159-166. [PMID: 36580313 PMCID: PMC9857514 DOI: 10.1001/jamaophthalmol.2022.3225] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Thyroid eye disease (TED) results in varying degrees of proptosis and diplopia negatively affecting quality of life (QoL), producing possibly substantial visual changes, disfigurement, and disability. Objective To determine the association of varying TED severities with QoL in a non-TED population by assessing health state utility scores. Design, Setting, and Participants This qualitative study, conducted from April 20, 2020, to April 29, 2021, assessed health states for active, moderate-severe TED, and values were elicited using time trade-off methods. Six health states of varying severity were determined from 2 placebo-controlled clinical trials (171 patients with TED and clinical activity score ≥4, ±diplopia/proptosis) and refined using interviews with US patients with TED (n = 6). Each health state description was validated by interviews with additional TED patient advocates (n = 3) and physician experts (n = 3). Health state descriptions and a QOL questionnaire were piloted and administered to a general population. Visual analog scales (VASs) were also administered to detect concurrence of the findings. Main Outcomes and Measures TED health state utility scores and whether they differ from one another were assessed using Shapiro-Wilk, Kruskal-Wallis, pairwise Wilcoxon rank sum, and paired t tests. Results A total of 111 participants completed time trade-off interviews. The mean (SD) utility value was 0.44 (0.34). The lowest (worse) mean utility value was observed in the most severe disease state (constant diplopia/large proptosis) with 0.30 (95% CI, 0.24-0.36), followed by constant diplopia/small proptosis (0.34; 95% CI, 0.29-0.40), intermittent or inconstant diplopia/large proptosis (0.43; 95% CI, 0.36-0.49), no diplopia/large proptosis (0.46; 95% CI, 0.40-0.52), and intermittent or inconstant diplopia/small proptosis (0.52; 95% CI, 0.45-0.58). The highest (best) mean value, 0.60 (95% CI, 0.54-0.67), was observed for the least severe disease state (no diplopia/small proptosis). Conclusions and Relevance These findings suggest that patients with active, moderate-severe TED may have substantial disutility, with increasing severity of proptosis/diplopia more likely to have detrimental associations with QoL. These health state scores may provide a baseline for determining QoL improvement in these TED health states (utility gains) treated with new therapies.
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Affiliation(s)
- Terry J. Smith
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, Ann Arbor, Michigan,Division of Metabolism, Endocrine and Diabetes, Michigan Medicine and University of Michigan, Ann Arbor
| | - Kimberly Cockerham
- Stanford Department of Ophthalmology, Palo Alto, California,Central Valley Eye Medical Group, Stockton, California,Senta Clinic, San Diego, California
| | - Gary Lelli
- Weill Cornell Medical Center, New York, New York
| | | | | | | | | | | | - Judah Lynch
- Adelphi Values PROVE, Manchester, United Kingdom
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A single-center analysis of visual outcomes and associated factors after intravenous methylprednisolone treatment for dysthyroid optic neuropathy. BMC Ophthalmol 2023; 23:32. [PMID: 36690985 PMCID: PMC9869532 DOI: 10.1186/s12886-023-02789-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Dysthyroid optic neuropathy (DON) is a serious threatening vision loss in Graves' ophthalmopathy (GO). Although the European Group on Graves' Ophthalmopathy (EUGOGO) recommend intravenous methylprednisolone therapy for first line treatment, some characteristics predicting the response are still inconclusive. AIM To study the efficacy of intravenous pulse methylprednisolone (IVMP) in treating dysthyroid optic neuropathy (DON) and to identify factors predicting poor response to the treatment. METHODS All patients diagnosed with DON between January 2010 and December 2021 at Rajavithi Hospital, Thailand, receiving IVMP 1 g/ day for 3 consecutive days were analyzed. The efficacy at 1 week and 3, 6, 12-months in terms of improvement of best corrected visual acuity (BCVA) and proptosis were compiled. RESULTS Of the entire 57 DON cases that received IVMP, 50.9% gained at least 0.2 Logarithm of the Minimum Angle of Resolution (logMAR) at 1 week, and the improvement from initial to 1-week BCVA was 0.63 ± 0.63 logMAR (p < 0.001) and the decrease in proptosis was 1.8 ± 1.36 mm (p < 0.001). The remaining 23 orbits underwent orbital decompression and were excluded from the long-term efficacy analysis. In the last 12-months' follow-up time, there was an improvement of BCVA (0.53 ± 0.47 logMAR) and proptosis (0.59 ± 0.66 mm) (both p < 0.001). At last visit, there was an improvement of BCVA (0.2 logMAR) and proptosis (2 mm) in 76.5, and 5.9% respectively. Significant predictive factors of poor treatment response were age ≥ 55 years (odds ratio [OR]: 8.28, 95% confidence interval [CI]: 1.368-50.121, p = 0.021); longer onset duration before treatment (OR: 5.10, 95%CI: 1.061-24.501, p = 0.042); and proptosis at baseline (OR: 9.31, 95%CI: 1.872-46.280, p = 0.006). The strongest risk factor for predicting poor response to IVMP was poor initial visual acuity (OR: 10.26, 95%CI: 1.363-77.234, p = 0.024). CONCLUSIONS IVMP is effective for both short- and long-term treatment to improve visual acuity greater than proptosis. Older age, longer disease duration, poor initial visual acuity, and proptotic orbits were identified as risk factors for predicting poor response to IVMP treatment in Thai population. DON patients having those risk factors should be suspected, and treated early with IVMP to preserve their future vision.
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Azizi F, Abdi H, Mehran L, Perros P, Masoumi S, Amouzegar A. Long-term follow-up of Graves' orbitopathy after treatment with short-term or long-term methimazole or radioactive iodine. Endocr Pract 2023; 29:240-246. [PMID: 36649782 DOI: 10.1016/j.eprac.2023.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/14/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this study was to compare long-term outcomes in terms of new onset or worsening of GO in patients with Graves' disease treated with different therapeutic modalities for hyperthyroidism. METHODS A total of 1163 patients with Graves' disease entered this study; 263 patients were treated with radioiodine and 808 patients received MMI therapy for a median of 18 months of whom, 178 patients continued MMI for a total of 96 months (long-term MMI). Thyroid hormonal status and GO were evaluated regularly for a median of 159 months since enrollment. RESULTS Rates of relapse, euthyroidism and hypothyroidism at the end of the follow-up were: radioiodine treatment: 16%, 22% and 62%, short-term MMI group: 59%, 36% and 5% and long-term MMI group: 18%, 80% and 2%, respectively. In the first 18 months of therapy, worsening of GO (11.5% vs 5.7%), and de novo development of GO (12.5% vs 9.8%) were significantly more frequent after radioiodine, p<0.004. The overall worsening and de novo development of GO from>18-234 months was 26(9.9%) in radioiodine and 8(4.5%) in LT-MMI groups, p<0.037. No case of worsening or new onset of GO was observed in patients treated with long-term MMI from>60-234 months of follow-up. CONCLUSION Progression and development of GO were associated more with radioiodine than MMI treatment; GO may appear de novo or worsen years after radioiodine but not after long-term MMI therapy.
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Affiliation(s)
- Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hengameh Abdi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle Upon Tyne, U.K
| | - Safdar Masoumi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Ye H, Sun A, Xiao W, Zhang T, Xu Z, Shi L, Sha X, Yang H. Differential Circular RNA Expression Profiling of Orbital Connective Tissue From Patients With Type I and Type II Thyroid-Associated Ophthalmopathy. Invest Ophthalmol Vis Sci 2022; 63:27. [DOI: 10.1167/iovs.63.12.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Huijing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Anqi Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Wei Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Te Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Zhihui Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Lu Shi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xiaotong Sha
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
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Zhang P, Zhu H. Cytokines in Thyroid-Associated Ophthalmopathy. J Immunol Res 2022; 2022:2528046. [PMID: 36419958 PMCID: PMC9678454 DOI: 10.1155/2022/2528046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 09/07/2023] Open
Abstract
Thyroid-associated ophthalmopathy (TAO), also known as thyroid eye disease (TED) or Graves' orbitopathy (GO), is a complex autoimmune condition causing visual impairment, disfigurement, and harm to patients' physical and mental health. The pathogenesis of TAO has not been fully elucidated, and the mainstream view is that coantigens shared by the thyroid and orbit trigger remodeling of extraocular muscles and orbital connective tissues through an inflammatory response. In recent years, cytokines and the immune responses they mediate have been crucial in disease progression, and currently, common evidence has shown that drugs targeting cytokines, such as tocilizumab, infliximab, and adalimumab, may be novel targets for therapy. In this review, we summarize the research development of different cytokines in TAO pathogenesis in the hope of discovering new therapeutic targets.
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Affiliation(s)
- Pengbo Zhang
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Huang Zhu
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
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Jafarzadeh A, Nemati M, Jafarzadeh S, Nozari P, Mortazavi SMJ. Thyroid dysfunction following vaccination with COVID-19 vaccines: a basic review of the preliminary evidence. J Endocrinol Invest 2022; 45:1835-1863. [PMID: 35347651 PMCID: PMC8960081 DOI: 10.1007/s40618-022-01786-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/13/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE The safety and efficacy of the several types of COVID-19 vaccines, including mRNA-based, viral vector-based, and inactivated vaccines, have been approved by WHO. The vaccines can confer protection against severe SARS-CoV-2 infection through induction of the anti-spike protein neutralizing antibodies. However, SARS-CoV-2 vaccines have been associated with very rare complications, such as thyroid disorders. This review was conducted to highlight main features of thyroid abnormalities following COVID-19 vaccination. METHODS A comprehensive search within electronic databases was performed to collect reports of thyroid disorders after vaccination with COVID-19 vaccines. RESULTS Among 83 reported cases including in this review, the most cases of thyroid abnormalities were observed after vaccination with mRNA-based vaccines (68.7%), followed by viral vector vaccines (15.7%) and 14.5% cases following inactivated vaccines. Subacute thyroiditis (SAT) was the most common COVID-19 vaccination-related thyroid disease, accounting for 60.2% of all cases, followed by Graves' disease (GD) with 25.3%. Moreover, some cases with focal painful thyroiditis (3.6%), silent thyroiditis (3.6%), concurrent GD and SAT (2.4%), thyroid eye disease (1.2%), overt hypothyroidism (1.2%), atypical subacute thyroiditis (1.2%), and painless thyroiditis with TPP (1.2%) were also reported. Overall, in 58.0% of SAT cases and in 61.9% of GD cases, the onset of the symptoms occurred following the first vaccine dose with a median of 10.0 days (ranged: 3-21 days) and 10.0 days (ranged: 1-60 days) after vaccination, respectively. Moreover, 40.0% of SAT patients and 38.1% of GD patients developed the symptoms after the second dose with a median of 10.5 days (ranged: 0.5-37 days) and 14.0 days (ranged: 2-35 days) after vaccination, respectively. CONCLUSION Fortunately, almost all cases with COVID-19 vaccination-associated thyroid dysfunctions had a favorable outcome following therapy. The benefits of COVID-19 vaccinations in terms of terminating the pandemic and/or reducing mortality rates can exceed any risk of infrequent complications such as a transient thyroid malfunction.
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Affiliation(s)
- A Jafarzadeh
- Department of Immunology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
- Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
- Department of Immunology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
| | - M Nemati
- Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Haematology and Laboratory Sciences, School of Para-Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - S Jafarzadeh
- Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - P Nozari
- Department of Immunology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - S M J Mortazavi
- Department of Medical Physics and Engineering, Shiraz University of Medical Sciences, Shiraz, Iran
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Califaretti E, Dall'armellina S, Rovera G, Finessi M, Deandreis D. The role of PET/CT in thyroid autoimmune diseases. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:218-228. [PMID: 35612371 DOI: 10.23736/s1824-4785.22.03464-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Autoimmune thyroid diseases (AITD) are a heterogeneous group of disorders. They include, in particular, Graves' disease and Hashimoto's thyroiditis with a wide range of different functional status ranging from subclinical biochemical abnormalities to severe hyperthyroidism or severe hypothyroidism respectively. Furthermore, other conditions more frequently infectious or drug related can cause an immune reaction in the thyroid tissue. In AITDs, positron emission tomography/computed tomography (PET/CT) does not play a primary role for disease diagnosis or management, but accidental findings can occur in both symptomatic and asymptomatic patients, and they should be recognized and well interpreted. A comprehensive literature search of the PubMed databases was conducted to identify papers (systematic review, prospective and retrospective study, case report) evaluating the role of PET/CT in thyroid autoimmune diseases. Thyroid diffuse uptake of 18F-fluoro-2-deoxy-2-d-glucose ([18F]FDG) has been shown to be frequently associated with AITDs, but also with immune-induced thyroid disorders related to SARS-CoV-2 or immunotherapy, while malignant lesions more often have a focal aspect. Other radiopharmaceuticals as [68Ga]-DOTA-peptides, [68Ga]-fibroblast activation protein inhibitors (FAPIs) and [68Ga]-prostate specific membrane antigen ([68Ga]-PSMA) showed similar findings. In conclusion, PET/CT scan in AITDs does not play a primary role in the diagnosis, but the occasional finding of a thyroid uptake must always be described in the report and possibly investigated for a better patient's management.
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Affiliation(s)
- Elena Califaretti
- Unit of Nuclear Medicine, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Sara Dall'armellina
- Unit of Nuclear Medicine, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Guido Rovera
- Unit of Nuclear Medicine, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Monica Finessi
- Unit of Nuclear Medicine, Department of Diagnostic Imaging and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy -
| | - Désirée Deandreis
- Unit of Nuclear Medicine, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
- Unit of Nuclear Medicine, Department of Diagnostic Imaging and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy
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27
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FitzPatrick AM. Is Estrogen a Missing Culprit in Thyroid Eye Disease? Sex Steroid Hormone Homeostasis Is Key to Other Fibrogenic Autoimmune Diseases - Why Not This One? Front Immunol 2022; 13:898138. [PMID: 35784325 PMCID: PMC9248759 DOI: 10.3389/fimmu.2022.898138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Sex bias in autoimmune disease (AID) prevalence is known, but the role of estrogen in disease progression is more complex. Estrogen can even be protective in some AIDs; but in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SSc), estrogen, its metabolites, and its receptors have been demonstrated to play critical, localized inflammatory roles. Estrogen is instrumental to the fibrosis seen in RA, SLE, SSc and other disease states, including breast cancer and uterine leiomyomas. Fibrotic diseases tend to share a common pattern in which lymphocyte-monocyte interactions generate cytokines which stimulate the deposition of fibrogenic connective tissue. RA, SLE, SSc and thyroid eye disease (TED) have very similar inflammatory and fibrotic patterns-from pathways to tissue type. The thorough investigations that demonstrated estrogen's role in the pathology of RA, SLE, and SSc could, and possibly should, be carried out in TED. One might even expect to find an even greater role for estrogen, and sex steroid homeostasis in TED, given that TED is typically sequalae to Graves' disease (GD), or Hashimoto's disease (HD), and these are endocrine disorders that can create considerable sex steroid hormone dysregulation. This paper highlights the pathophysiology similarities in 4 AIDs, examines the evidence of sex steroid mediated pathology across 3 AIDs and offers a case study and speculation on how this may be germane to TED.
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Expert Consensus on the Use of Teprotumumab for the Management of Thyroid Eye Disease Using a Modified-Delphi Approach. J Neuroophthalmol 2022; 42:334-339. [PMID: 35421877 PMCID: PMC9377484 DOI: 10.1097/wno.0000000000001560] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Supplemental Digital Content is Available in the Text. Teprotumumab is the first treatment for thyroid eye disease (TED), a debilitating autoinflammatory condition, approved by the Food and Drug Administration in the United States, which reduces proptosis and improves quality of life. In the absence of guidelines, clinical recommendations were developed for using teprotumumab in patients with TED in the United States.
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Bontzos G, Papadaki E, Mazonakis M, Maris TG, Tsakalis NG, Drakonaki EE, Detorakis ET. Extraocular Muscle Volumetry for Assessment of Thyroid Eye Disease. J Neuroophthalmol 2022; 42:e274-e280. [PMID: 34629402 DOI: 10.1097/wno.0000000000001339] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In this study we evaluate the diagnostic accuracy of extraocular muscle volumetry in detecting thyroid eye disease and to compare the results with simple measurements of maximal medial rectus (MR) diameter. METHODS Cross-sectional study that included 47 eyes of 47 patients with thyroid eye disease and 47 healthy controls. Patients underwent slitlamp examination and imaging consisting of computed tomography scans. Image segmentation and volume measurements were performed by 2 independent researchers. Intraobserver and interobserver reliability testing was also conducted. RESULTS Total extraocular muscle volume was 7.31 ± 1.88 cm3 and medial volume was 2.38 ± 0.73 cm3 in the study group. In this group, the maximum measured diameter of the MR was 6.67 ± 0.35 mm. MR volume was statistically associated with maximum MR diameter (r = 9.78; P < 0.001). Both MR volume and maximum MR diameter measurements showed good predictive efficacy as shown using receiver operator characteristic curve analysis. CONCLUSIONS Complications of thyroid eye disease are often sight threatening, and timely diagnosis is crucial for the management of the entity and its sequelae. The results of this study imply that simple measurements of maximum MR diameter are sensitive enough to establish diagnosis.
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Affiliation(s)
- Georgios Bontzos
- Departments of Ophthalmology (GB, NGT, ETD), and Radiology (EP), University Hospital of Heraklion, Heraklion, Greece ; Department of Medical Physics (MM, TGM), University of Crete, Heraklion, Greece; and Independent Imaging Services (EED), Heraklion, Crete, Greece
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Tagami M, Honda S, Azumi A. Insights into Current Management Strategies for Dysthyroid Optic Neuropathy: A Review. Clin Ophthalmol 2022; 16:841-850. [PMID: 35330749 PMCID: PMC8939905 DOI: 10.2147/opth.s284609] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/10/2022] [Indexed: 01/20/2023] Open
Abstract
Dysthyroid optic neuropathy (DON) is a potentially sight-threatening eye disease associated with Graves’ orbitopathy (GO). DON is not common in GO patients, reportedly occurring in only about 5% of patients. The pathogenesis of severe DON is considered to involve both muscular nerve strangulation and impaired blood flow. There is some objective grading of physical examination findings and the severity of GO, including a clinical activity score (CAS) and EUropean Group On Graves’ Orbitopathy (EUGOGO), but no specialized protocol completely characterizes DON. Most clinicians have decided that the combination of clinical activity findings, including visual acuity, color vision, and central critical fusion frequency, and radiological findings, including magnetic resonance imaging (MRI), can be used to diagnose DON. MRI has the most useful findings, with T2-weighted and fat-suppressed images using short-tau inversion recovery (STIR) sequences enabling detection of extraocular changes including muscle and/orbital fat tissue swelling and inflammation and, therefore, disease activity. The first-choice treatment for DON is intravenous administration of steroids, with or without radiotherapy. Unfortunately, refractoriness to this medical treatment may indicate the need for immediate orbital decompression within 2 weeks. Especially in the acute phase of DON, thyroid function is often unstable, and the surgeon must always assume the risk of general anesthesia and intra- and post-operative management. In addition, there are currently many possible therapeutic options, including molecular-targeted drugs. The early introduction and combination of these immunomodulators, including Janus kinase inhibitors and insulin-like growth factor-1 receptor antibody (teprotumumab), may be effective for GO with DON. However, this is still under investigation, and the number of case reports is small. It is possible that these options could reduce systemic adverse events due to unfocused glucocorticoid administration. The pathophysiology of DON is not yet fully understood, and further studies of its treatment and long-term visual function prognosis are needed.
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Affiliation(s)
- Mizuki Tagami
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Correspondence: Mizuki Tagami, Department of Ophthalmology and Visual Science, Graduate School of Medicine, Osaka City University, 1-5-7 Asahimachi, Abeno-ku, Osaka-shi, 545-8586, Japan, Tel/Fax +81-6-6645-3867, Email
| | - Shigeru Honda
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Atsushi Azumi
- Ophthalmology Department and Eye Center, Kobe Kaisei Hospital, Kobe, Hyogo, Japan
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Albrashdi S, Alsharqi H, Habroosh F, Eatamadi H. Tocilizumab use in pediatric thyroid eye disease: First documented case. Am J Ophthalmol Case Rep 2022; 25:101387. [PMID: 35198812 PMCID: PMC8851154 DOI: 10.1016/j.ajoc.2022.101387] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose To report the first case of Tocilizumab treatment for progressive pediatric thyroid eye disease (TED) in a 9-year-old female. Observations A 9-year-old female with a history of hyperthyroidism for 4 months presented with bilateral proptosis (more in the right eye) associated with retrobulbar pain, tearing, and conjunctival and caruncular redness. The exophthalmometry reading on presentation was 21mm OD and 17 mm OS. The patient was managed with observation and control of hyperthyroidism in the beginning. However, on a subsequent visit 3 months later it was observed that the symptoms and clinical findings were rapidly worsening. The exophthalmometry reading upon subsequent follow-up was 22 OD and 22 OS. After multidisciplinary team (MDT) discussions it was decided to treat the patient with four doses of 8mg/kg Tocilizumab injection on monthly basis. Notable improvement of proptosis and resolution of pain, conjunctival and caruncular redness was observed. The exophthalmometry reading 4 months after treatment was 20 OD and 19 OS. Conclusion and importance This case report opens an important gateway for the use of Tocilizumab in progressive TED in pediatric age groups.
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Affiliation(s)
- Safiya Albrashdi
- Sheikh Khalifa Medical City (SKMC), Al Karamah St - Al TibbiyaW13-01, Abu Dhabi, United Arab Emirates
| | - Hessah Alsharqi
- Sheikh Khalifa Medical City (SKMC), Al Karamah St - Al TibbiyaW13-01, Abu Dhabi, United Arab Emirates
| | - Fatima Habroosh
- Sheikh Khalifa Medical City (SKMC), Al Karamah St - Al TibbiyaW13-01, Abu Dhabi, United Arab Emirates
| | - Habibullah Eatamadi
- Sheikh Shakhbout Medical City (SSMC), Ghweifat International Highway, Abu Dhabi, United Arab Emirates
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Douglas RS, Dailey R, Subramanian PS, Barbesino G, Ugradar S, Batten R, Qadeer RA, Cameron C. Proptosis and Diplopia Response With Teprotumumab and Placebo vs the Recommended Treatment Regimen With Intravenous Methylprednisolone in Moderate to Severe Thyroid Eye Disease: A Meta-analysis and Matching-Adjusted Indirect Comparison. JAMA Ophthalmol 2022; 140:328-335. [PMID: 35175308 PMCID: PMC8855315 DOI: 10.1001/jamaophthalmol.2021.6284] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Thyroid eye disease can be a debilitating autoimmune disorder characterized by progressive proptosis or diplopia. Teprotumumab has been compared with placebo in randomized clinical trials, but not with intravenous methylprednisolone (IVMP), which sometimes is used in clinical practice for this condition. Objective To conduct a matching-adjusted indirect comparison of teprotumumab vs IVMP vs placebo. Data Sources Deidentified patient-level data from teprotumumab trials and aggregate-level data from literature on the most recommended regimen of IVMP. Study Selection PubMed and Embase were searched for randomized/observational studies using key terms and controlled vocabulary. Full texts of eligible articles were reviewed and cataloged. Data Extraction and Synthesis Conducted by 1 reviewer (R.A.Q.) and 1 verifier (R.B.), including study characteristics, eligibility criteria, baseline characteristics, and outcomes. Main Outcomes and Measures Changes in proptosis by millimeter and diplopia response (percentage with ≥1 grade reduction) from baseline to week 12 in patients receiving IVMP and placebo, and to week 24 in patients receiving teprotumumab. Results The search identified 1019 records, and 6 through manual searches, alerts, and secondary references. After excluding duplicates and screening full-text records, 12 IVMP studies were included in the matching-adjusted indirect comparison (11 for proptosis change [n = 419], 4 for diplopia response [n = 125], and 2 teprotumumab [n = 79] and placebo [n = 83] comparator studies). Treatment with IVMP resulted in a proptosis difference of -0.16 mm (95% CI, -1.55 to 1.22 mm) from baseline to week 12 vs placebo. The proptosis treatment difference between IVMP and teprotumumab of -2.31 mm (95% CI, -3.45 to -1.17 mm) favored teprotumumab. Treatment with IVMP (odds ratio, 2.69; 95% CI, 0.94-7.70) was not favored over placebo in odds of diplopia response; however, teprotumumab was favored over IVMP (odds ratio, 2.32; 95% CI, 1.07-5.03). Conclusions and Relevance This meta-analysis suggests that use of IVMP is associated with a small, typically not clinically relevant, change from baseline in proptosis vs placebo, with modest changes in diplopia. While this nonrandomized comparison suggests that use of teprotumumab, compared with IVMP, is associated with greater improvements in proptosis and may be twice as likely to have a 1 grade or higher reduction in diplopia, randomized trials comparing these 2 treatments would be warranted to determine if 1 treatment is superior to the other to a clinically relevant degree.
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Affiliation(s)
| | | | | | | | - Shoaib Ugradar
- Jules Stein Eye Institute, University of California, Los Angeles
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The changes of retinal nerve fibre layer and ganglion cell layer with different severity of thyroid eye disease. Eye (Lond) 2022; 36:129-134. [PMID: 33637966 PMCID: PMC8727574 DOI: 10.1038/s41433-021-01453-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/17/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To evaluate the changes of retinal nerve fibre layer (RNFL) and ganglion cell layer/inner plexiform layer (GCL/IPL) with the severity of thyroid eye disease (TED). METHODS One hundred and forty-five eyes of 75 patients with TED and 70 eyes of 35 healthy controls were included. The eyes with TED were divided into mild group (35 eyes), moderate-to-severe group (42 eyes) and DON group (68 eyes). The thickness of RNFL and GCL/IPL were measured by optic coherence tomography (OCT). Clinical activity score (CAS), best corrected visual acuity (BCVA), intraocular pressure (IOP), proptosis and mean deviation (MD) by Humphrey perimetry were assessed. RESULTS The CAS had significant difference between the three groups (p < 0.001). The proptosis and IOP were significantly higher in DON group and moderate-to-severe group than mild group (p < 0.05). The MD and BCVA were significantly worse in DON group compared with mild group and moderate-to-severe group (p < 0.001). The mean GCL/IPL thickness was thinnest in DON group (p < 0.001). The mean RNFL thickness had significant difference between moderate-to-severe group and DON group (p = 0.036). The mean GCL/IPL thickness had a significant correlation with MD (r = 0.449, p < 0.001) and VA (r = -0.388, p < 0.001), whereas the mean RNFL thickness had no significant correlation with MD (p = 0.082) or VA (p = 0.226). CONCLUSIONS Subclinical optic neuropathy might progress in the patients with moderate-to-severe TED. OCT measurements of GCL/IPL and RNFL are useful to detect the early changes of optic nerve. The thinning of GCL/IPL might be a strong suggestion for closer vision follow-up and earlier decompression surgery.
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Osaki M, Osaki T, Monteiro L. Management of eyelid retraction related to thyroid eye disease. Taiwan J Ophthalmol 2022; 12:12-21. [PMID: 35399960 PMCID: PMC8988987 DOI: 10.4103/tjo.tjo_57_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Eyelid retraction related to thyroid eye disease (TED) is a challenging condition. It is one of the main clinical signs and a major diagnostic criterion in TED. This condition may threaten vision due to exposure keratopathy, in addition to its esthetic alterations, which may lead to psychosocial implications and affect the patient's quality of life. Although it is more commonly observed in the upper eyelid, it may be present on both the upper and lower lids. Numerous surgical and nonsurgical treatment modalities have been described and will be reviewed in this article. Management should be based on an individual patient assessment, taking into consideration the disease stage, severity, and clinician experience.
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Draman MS, Zhang L, Dayan C, Ludgate M. Orbital Signaling in Graves' Orbitopathy. Front Endocrinol (Lausanne) 2021; 12:739994. [PMID: 34899596 PMCID: PMC8660111 DOI: 10.3389/fendo.2021.739994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Graves' orbitopathy (GO) is a complex and poorly understood disease in which extensive remodeling of orbital tissue is dominated by adipogenesis and hyaluronan production. The resulting proptosis is disfiguring and underpins the majority of GO signs and symptoms. While there is strong evidence for the thyrotropin receptor (TSHR) being a thyroid/orbit shared autoantigen, the insulin-like growth factor 1 receptor (IGF1R) is also likely to play a key role in the disease. The pathogenesis of GO has been investigated extensively in the last decade with further understanding of some aspects of the disease. This is mainly derived by using in vitro and ex vivo analysis of the orbital tissues. Here, we have summarized the features of GO pathogenesis involving target autoantigens and their signaling pathways.
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Affiliation(s)
- Mohd Shazli Draman
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff, United Kingdom
- KPJ Healthcare University College, Nilai, Malaysia
| | - Lei Zhang
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Colin Dayan
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Marian Ludgate
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff, United Kingdom
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Iñiguez-Ariza NM, Sharma A, Garrity JA, Stan MN. The "Quiet TED"-A Special Subgroup of Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2021; 37:551-555. [PMID: 33782324 DOI: 10.1097/iop.0000000000001942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Thyroid eye disease (TED) or Graves' orbitopathy starts with an active inflammatory stage (active disease) followed by resolution of inflammation and progression to a fibrotic, inactive stage. In our practice, we have encountered cases that have not had active disease despite presence of fibrotic sequelae and disease progression. We aim to delineate the clinical characteristic of this unique group of patients. METHODS We conducted a single-center (Mayo Clinic Rochester) retrospective chart review of TED patients who throughout the course of their disease had only evidence for inactive TED, defined as clinical activity score <3. RESULTS Median age in the cohort (n = 19) was 54 years (IQR 47-61). 58% had a prior diagnosis of Graves' disease (GD) before referral. 80% (n = 15) were euthyroid at the time of TED onset (median thyroid-stimulating hormone 1.7 mIU/L). The most common finding was diplopia (100%, n = 19) followed by proptosis (63%, n = 12). Interestingly the disease was asymmetric in 42% of cases. Overall median clinical activity score on presentation was 1 (IQR 0-1). Severity wise, 85% (n = 16) of patients were classified as moderate-to-severe during follow up. Orbital decompression was performed in only 1 case, while extraocular muscle surgery was performed in 13 cases. CONCLUSIONS Quiet TED is a subgroup of TED patients that defies the classic disease paradigm. It presents primarily with diplopia and proptosis. Further evaluation of this group might identify useful insights in TED pathophysiology and help optimize therapeutic choices.
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Affiliation(s)
- Nicole M Iñiguez-Ariza
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Anu Sharma
- Division of Endocrinology, Metabolism, and Diabetes, University of Utah School of Medicine, Salt Lake City, Utah
| | - James A Garrity
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Marius N Stan
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota
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Detiger SE, Kremer TM, A.S.H. Dalm V, de Keizer RO, Wubbels RJ, Metselaar J, van Hagen PM, Peeters RP, Paridaens D. A pilot study on the use of prednisolone-encapsulated liposomes for the treatment of moderate-to-severe Graves' orbitopathy with reduced systemic steroid exposure. Acta Ophthalmol 2021; 99:797-804. [PMID: 33423386 DOI: 10.1111/aos.14751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/29/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To demonstrate that long-circulating PEGylated liposomal prednisolone is a safe and effective therapy in patients with active moderate-to-severe Graves' orbitopathy. METHODS Open-label, proof-of-concept, multicentre pilot study. Ten patients with moderate-to-severe Graves's orbitopathy, who were euthyroid for at least three months. Long-circulating PEGylated liposomal prednisolone 150 mg was administered intravenously twice, with 2-week interval. Total follow-up was 12 months, with visits at baseline, week 2, 6, 13, 26 and 52. Physical, laboratory and ophthalmological examinations were performed. Response to treatment was defined as a reduction in Clinical Activity Score by ≥2 points; palpebral aperture by ≥3 mm; soft tissue signs by ≥2 grades; exophthalmos by ≥2 mm; and motility by >8 degrees or improvement in diplopia score. A response was sustained when equally observed at weeks 6 and 13. RESULTS One patient achieved a sustained response according to the predetermined definition. All patients showed a decrease in Clinical Activity Score after one infusion, with a mean decrease of two points. The Clinical Activity Score was ≤1 at week 52 for all patients. Improvement was also observed in the soft tissue signs. Most of the adverse events were mild and of a transient nature. Two patients required further treatment with intravenous methylprednisolone. CONCLUSION This pilot study showed a positive effect of long-circulating PEGylated liposomal prednisolone on the Clinical Activity Score in patients with moderate-to-severe Graves's orbitopathy, resulting in fewer hospital visits and possibly less glucocorticoid-related side-effects.
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Affiliation(s)
| | | | - Virgil A.S.H. Dalm
- Department of Internal Medicine Division of Clinical Immunology & Department of Immunology Erasmus University Medical Center Rotterdam Rotterdam the Netherlands
| | - Ronald O.B. de Keizer
- The Rotterdam Eye Hospital Division of Oculoplastic, Orbital and Lacrimal Surgery Rotterdam the Netherlands
| | - Rene J. Wubbels
- The Rotterdam Ophthalmic Institute Rotterdam the Netherlands
| | - J.M. Metselaar
- Institute for Experimental Molecular Imaging, RWTH Aachen University Clinic, Forckenbeckstrasse 55, 52074 Aachen, Germany
| | - P. Martin van Hagen
- Department of Internal Medicine Division of Clinical Immunology & Department of Immunology Erasmus University Medical Center Rotterdam Rotterdam the Netherlands
| | - Robin P. Peeters
- Department of Internal Medicine Division of Endocrinology Erasmus University Medical Center Rotterdam Rotterdam the Netherlands
| | - Dion Paridaens
- The Rotterdam Eye Hospital Division of Oculoplastic, Orbital and Lacrimal Surgery Rotterdam the Netherlands
- Department of Ophthalmology Erasmus Medical Center Rotterdam Rotterdam the Netherlands
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Kang J, Lechuga M, Braun J, Kossler A, Douglas R, Cockerham K. Infusion Center Guidelines for Teprotumumab Infusions: Informed Consent, Safety, and Management of Side Effects. JOURNAL OF INFUSION NURSING 2021; 44:331-338. [PMID: 34753152 PMCID: PMC10853843 DOI: 10.1097/nan.0000000000000446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Teprotumumab was the first and only medication approved by the US Food and Drug Administration for the treatment of thyroid eye disease in January 2020. Thyroid eye disease is a complex autoimmune inflammatory disease that can be sight-threatening, debilitating, and disfiguring to affected patients. Although biologic therapies are a preferred treatment option for many complex immunologic and oncologic conditions, their use in ophthalmology and endocrinology may be more novel. The goals of this article are to introduce this new therapeutic option; discuss its mechanism of action, indications for use, administration protocol, infusion precautions, and informed consent; and review common side effects and management.
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Affiliation(s)
- Julia Kang
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| | - Maria Lechuga
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| | - Jenna Braun
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| | - Andrea Kossler
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| | - Raymond Douglas
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| | - Kimberly Cockerham
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
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Bećarević MB, Matutinović MS, Žarković M, Beleslin BN, Ćirić J, Ignjatović SD. Antiphospholipid antibodies in patients with Graves' orbitopathy: preliminary data. Endocrine 2021; 74:349-354. [PMID: 34037961 DOI: 10.1007/s12020-021-02769-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Graves' orbitopathy (GO) is an inflammatory autoimmune disorder of the orbit and while the antiphospholipid antibodies (aPL) Abs were associated with the markers of inflammation in the antiphospholipid syndrome (APS), there is no literature that investigate the presence of aPL Abs in GO. We analyzed the prevalence of aPL Abs and the differences between aPL (+) and aPL (-) subgroups of GO patients. METHODS Study included consecutive patients with GO (66 with Graves' (GD), 10 with Hashimoto (HD), and 8 were euthyroid). Anticardiolipin (aCL) and anti-beta 2glycoprotein I (aβ2gpI) Abs were measured by ELISA. RESULTS aPL Abs were present in 9/84 (10.71%) patients. The IgM aβ2gpI Abs were present in 8/66 and in 1/10 patients with GD and HD. The IgG aCL Abs were present in one GD patient, and IgM aCL were present in 3/66 GD and in 1/10 patients with HD. In GD group, anti-Tg Abs were in positive correlation with aβ2gpI IgG (p = 0.000) and with anti-TPO Abs (p = 0.016). In HD group, anti-Tg Abs were in positive correlation with IgM aCL (p = 0.042), while anti-TPO Abs were in positive correlation with aβ2gpI IgM (p = 0.014). CONCLUSION This study is the first report of the aPL Abs presence in GO patients. The anti-thyroid Abs were linked to aPL suggesting that their presence is not the sole consequence of hyperstimulation of autoreactive B-lymphocytes. Larger studies are necessary to confirm potential cause-effect relations.
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Affiliation(s)
- Mirjana B Bećarević
- University of Novi Sad, Faculty of Medicine, Department of Pharmacy, Novi Sad, Serbia.
| | - Marija Sarić Matutinović
- University of Belgrade, Faculty of Pharmacy, Department of Medical Biochemistry, Belgrade, Serbia
| | - Miloš Žarković
- University of Belgrade, School of Medicine, Belgrade, Serbia and Clinic of Endocrinology, diabetes and metabolic diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Biljana Nedeljković Beleslin
- University of Belgrade, School of Medicine, Belgrade, Serbia and Clinic of Endocrinology, diabetes and metabolic diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Jasmina Ćirić
- University of Belgrade, School of Medicine, Belgrade, Serbia and Clinic of Endocrinology, diabetes and metabolic diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Svetlana D Ignjatović
- University of Belgrade, Faculty of Pharmacy, Department of Medical Biochemistry, Belgrade, Serbia
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40
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Zhou M, Wu D, Yu F, Hong S, Ye J, Wang C, Li Y, Du M, Xiao H, Wan P. Corneal Endothelium: A Promising Quantitative Index for Graves Ophthalmopathy Activity Evaluation. Am J Ophthalmol 2021; 230:216-223. [PMID: 34102155 DOI: 10.1016/j.ajo.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/04/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the corneal endothelium damage in Graves ophthalmopathy (GO) and its role as a promising quantitative index to evaluate GO activity. DESIGN Cross-sectional study. METHODS This study included 128 eyes of 64 patients with GO. All subjects underwent ophthalmologic examinations, including proptosis, tear break-up time (BUT), corneal fluorescein staining, and Schirmer test. Corneal endothelium was measured by noncontact specular microscope and ocular biometric parameters were measured by IOLMaster 700. Each eye was assigned a specific clinical activity score (CAS), then grouped as active (CAS ≥3 points) or inactive (CAS <3 points). Ocular parameters between the 2 groups were compared using generalized estimating equations accounting for inter-eye correlation, and receiver operating characteristic (ROC) curves were also obtained. Main outcome measures were parameters of corneal endothelium. RESULTS Among the included eyes, 81 eyes had inactive GO and 47 eyes had active GO. Corneal endothelial cell morphology was altered in active GO compared with inactive GO. The coefficient variation of cell area (CV) was significantly higher in active GO compared with inactive GO (37.0 [34.4-41.2]% vs 33.9 [30.9-36.8]%, P = .001), and positively correlated with CAS (r = 0.322, P < .001). Moreover, CV showed a diagnostic capacity to differentiate the active eyes from inactive eyes. The area under the ROC curve was 0.705. CONCLUSIONS Active GO had morphologic changes in corneal endothelium compared with inactive GO. CV is a sensitive indicator to reflect corneal endothelial function, and has the potential to be adopted as a noninvasive, objective, and quantitative index for evaluating the activity status of GO patients.
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Li Y, Luo B, Zhang J, Zhou X, Shao S, Xu W, Yang Y, Yuan G. Clinical relevance of serum immunoglobulin G4 in glucocorticoid therapy of Graves' ophthalmopathy. Clin Endocrinol (Oxf) 2021; 95:657-667. [PMID: 33938028 DOI: 10.1111/cen.14493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Previous study suggested IgG4 levels were associated with the development of Graves' ophthalmopathy (GO). The aims of the present study were to investigate the role of IgG4 levels in glucocorticoid (GC) treatment in GO patients. DESIGN 69 GO patients were enrolled. Serum thyroid hormones, thyroid antibodies, IgG, IgG4, ophthalmological examinations and orbital MRI were performed. Furthermore, the clinical outcomes (a composite response endpoint including the clinical activity score (CAS), proptosis, vision, intraocular pressure, diplopia and lid width) after high-dose intravenous GC treatment in 32 active moderate-to-severe GO patients were compared. PATIENTS 69 consecutive patients with GO were asked to participate in the study. 32 of 69 GO patients were treated with high-dose intravenous GCs. MEASUREMENTS Measurement of serum IgG and IgG4, serum thyroid hormones and thyroid autoantibodies. An overall ophthalmic assessment was performed pretherapy (week 0) and post-therapy (week 12). RESULTS 33.3% of GO patients (23/69) had elevated IgG4 levels. IgG4 levels were positively correlated with the severity and activity of GO. After GC therapy, IgG4, IgG4/IgG, vision and CAS were significantly improved in GO patients. Patients with high IgG4 levels had a significantly reduced extraocular muscle area (EOMs) and better clinical outcomes than patients with normal IgG4 levels. CONCLUSIONS Our results suggest a possible subgroup of elevated IgG4 GO patients, with more severe ophthalmopathy and better response to GCs treatment compare with normal IgG4 GO patients.
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Affiliation(s)
- Yaling Li
- Department of Endocrinology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Unit, Wuhan Hospital of Traditional Chinese and Western Medical, Wuhan, China
| | - Ban Luo
- Department of Ophthalmology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Zhang
- Department of Radiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xinrong Zhou
- Department of Endocrinology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shiying Shao
- Department of Endocrinology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Weijie Xu
- Department of Endocrinology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Yang
- Department of Endocrinology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Yuan
- Department of Endocrinology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Leitner I, Andrianakis A, Gellner V, Kiss P, Andrianakis D, Tomazic PV. Optic nerve injury in preoperative imaging is associated with visual improvement outcome in endoscopic optic nerve decompression. Wien Klin Wochenschr 2021; 134:185-194. [PMID: 34342713 PMCID: PMC8921008 DOI: 10.1007/s00508-021-01915-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/28/2021] [Indexed: 01/21/2023]
Abstract
Objective To evaluate potential clinical parameters having an impact on visual outcome after endoscopic optic nerve decompression in acute optic neuropathy patients. Methods A retrospective chart review of patients with acute optic neuropathy, who underwent endoscopic optic nerve decompression between June 2001 and November 2018 at an academic center was performed. Patients were divided into groups according to visual improvement after surgical treatment (yes/no). Following clinical parameters were compared between groups: perioperative steroid use, evidence of optic nerve affection in preoperative neuroimaging, additional optic nerve sheath incision, surgery delay and preoperative C-reactive protein (CRP) levels. Further subgroups analyses were conducted based on etiology (trauma/tumor). Results Among 32 included cases, 16 patients (50%) reported visual improvement after endoscopic optic nerve decompression. There was no significant difference in visual improvement between etiology subgroups (trauma: n = 9/20 (45%) vs. tumor: n = 7/12 (58.3%), p = 0.465). Tumor subgroup patients with visual improvement had a significantly higher prevalence of optic nerve affection in preoperative neuroimaging than those without visual improvement (p = 0.018, φ = 0.683). Perioperative steroid administration was negatively associated with visual outcome (p = 0.034, φ = 0.375). Nerve sheath incision, surgery delay and preoperative CRP levels did not have a significant impact on visual outcome (p > 0.05). Conclusion Radiological findings can help as an indicator for surgical treatment since an affected optic nerve in preoperative neuroimaging resulted in better visual outcome after surgery. The use of steroids should be considered more carefully since it did not show any beneficial effect.
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Affiliation(s)
- Isabella Leitner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Alexandros Andrianakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria.
| | - Verena Gellner
- Department for Neurosurgery, Medical University of Graz, Graz, Austria
| | - Peter Kiss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Damianos Andrianakis
- Institute of Mathematics and Scientific Computing, University of Graz, Graz, Austria
| | - Peter Valentin Tomazic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
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Zhou F, Liang Z, Wang X, Tan G, Wei W, Zheng G, Ma X, Tian D, Li H, Yu H. The VDR gene confers a genetic predisposition to Graves' disease and Graves' ophthalmopathy in the Southwest Chinese Han population. Gene 2021; 793:145750. [PMID: 34077777 DOI: 10.1016/j.gene.2021.145750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Graves' disease (GD) is a common autoimmune disease manifesting with diffuse symmetric thyroid gland enlargement, pretibial myxedema, and Graves' ophthalmopathy (GO). Recently, the vitamin D receptor (VDR) gene has been linked to various autoimmune diseases. This study aimed to investigate the association of VDR gene polymorphisms with susceptibility to GD and GO in the Southwest Chinese Han population. METHODS A two-stage association study was performed in 1,209 controls and 650 GD patients by PCR-RFLP assay. Real-time PCR and ELISA were carried out to quantify gene expression and cytokine production. RESULTS The first-stage study showed that the frequency of VDR/Apa I AA genotype was significantly increased in GD (Pc = 1.67 × 10-2, OR = 1.98). The second-stage and combined studies confirmed the association of VDR/Apa I with GD (AA genotype: Pc = 3.45 × 10-4, OR = 1.87; A allele: Pc = 2.62 × 10-2, OR = 1.20). The stratification analysis showed that GO patients had a higher frequency of the VDR/Apa I AA genotype (Pc = 8.69 × 10-5, OR = 2.84). Functional experiments showed a decreased VDR expression and TGF-β1 production as well as an increased IL-17 production in VDR/Apa I AA genotype carriers. CONCLUSION The VDR/Apa I polymorphism is significantly associated with GD and GO, and it may be involved in the development of GD and GO by influencing VDR mRNA expression levels and the secretion levels of cytokines.
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Affiliation(s)
- Fangyu Zhou
- School of Basic Medical Sciences, Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Guizhou 563000, China
| | - Zhongzhi Liang
- Affiliated Hospital of Zunyi Medical University, Guizhou 563000, China
| | - Xin Wang
- School of Basic Medical Sciences, Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Guizhou 563000, China
| | - Guiqin Tan
- School of Basic Medical Sciences, Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Guizhou 563000, China
| | - Wenwen Wei
- School of Basic Medical Sciences, Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Guizhou 563000, China
| | - Guangbing Zheng
- School of Basic Medical Sciences, Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Guizhou 563000, China
| | - Xiaomin Ma
- School of Basic Medical Sciences, Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Guizhou 563000, China
| | - Dan Tian
- School of Basic Medical Sciences, Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Guizhou 563000, China
| | - Hua Li
- Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, China
| | - Hongsong Yu
- School of Basic Medical Sciences, Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Guizhou 563000, China.
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Pinto W, Romaldini JH, Perini N, Santos RB, Villagelin D. The change in the clinical presentation of Graves' disease: a 30 years retrospective survey in an academic Brazilian tertiary center. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 64:514-520. [PMID: 34033290 PMCID: PMC10118967 DOI: 10.20945/2359-3997000000265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Graves' disease (GD) is the main cause of hyperthyroidism among adults. It is an autoimmune condition classically marked by the Merserburg Triad (goiter, thyrotoxicosis, and orbitopathy), but the change in presentation of GD over time has rarely been studied. To determine changes in the clinical presentation of patients with GD in the last 30 years. Methods The study evaluated 475 patients diagnosed with GD between 1986 and 2016 in a single center. Patients were evaluated regarding epidemiological aspects, thyroid function, inflammatory activity of the eyes evaluated by the Clinical Activity Score; CAS, severity evaluated by NOSPECS classification and thyroid volume estimated by ultrasonography. Results Patients assessment identified an increase in the mean age of diagnosis of GD (p < 0.02), a reduction in thyroid volume (p < 0.001) and less intense orbital involvement from 2007-2016 compared to 1986-2006 (p = 0.04). The number of smoking patients was smaller from 2007 to 2016 (28.7%) than 1986 to 2006 (42.8% p = 0.001). The TSH and TRAb values did not had significant changes. Conclusion GD presentation appears to be changed in the last years compared to the typical initial presentation. There is a less frequent inflammatory involvement of orbital tissue, smaller goiters, a lower number of smokers and diagnosis at older age.
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Affiliation(s)
- Wanesa Pinto
- Curso de Pós-Graduação em Medicina Interna, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - João H Romaldini
- Endocrinologia e Metabolismo, Hospital da Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil
| | - Nicolas Perini
- Endocrinologia e Metabolismo, Hospital da Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil
| | - Roberto B Santos
- Endocrinologia e Metabolismo, Hospital da Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil
| | - Danilo Villagelin
- Endocrinologia e Metabolismo, Hospital da Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil,
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Winn BJ, Kersten RC. Teprotumumab: Interpreting the Clinical Trials in the Context of Thyroid Eye Disease Pathogenesis and Current Therapies. Ophthalmology 2021; 128:1627-1651. [PMID: 33930408 DOI: 10.1016/j.ophtha.2021.04.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022] Open
Abstract
Teprotumumab, a monoclonal antibody targeted against the insulin-like growth factor 1 (IGF-1) receptor, was recently approved by the United States Food and Drug Administration for the treatment of thyroid eye disease (TED). Phase 1 studies of teprotumumab for the treatment of malignancies demonstrated an acceptable safety profile but limited effectiveness. Basic research implicating the IGF-1 receptor on the CD-34+ orbital fibrocyte in the pathogenesis of TED renewed interest in the drug. Two multicenter, randomized, double-masked, clinical trials (phase 2 and 3) evaluated the efficacy of 8 infusions of teprotumumab every 3 weeks versus placebo in 170 patients with recent-onset active TED, as defined by a clinical activity score (CAS) of at least 4. Teprotumumab was superior to placebo for the primary efficacy end points in both studies: overall responder rate as defined by a reduction of 2 or more CAS points and a reduction of 2 mm or more in proptosis (69% vs. 20%; P < 0.001; phase 2 study) and proptosis responder rate as defined by a reduction of 2 mm or more in proptosis (83% vs. 10%; P < 0.001; phase 3 study). In both studies, treatment with teprotumumab compared with placebo achieved a significant mean reduction of proptosis (-3.0 mm vs. -0.3 mm, phase 2 study; -3.32 mm vs. -0.53 mm, phase 3 study) and CAS (-4.0 vs. -2.5, phase 2 study; -3.7 vs. -2.0, phase 3 study). Teprotumumab also resulted in a greater proportion of patients with a final CAS of 0 or 1, higher diplopia responder rate, and a larger improvement in the Graves' Ophthalmopathy Quality of Life overall score. More than half of patients (62%, phase 2 trial; 56%, phase 3 trial) who were primary end point responders maintained this response at 51 weeks after the last dose of therapy. The most common adverse events reported with teprotumumab included muscle spasms (25%), nausea (17%), alopecia (13%), diarrhea (13%), fatigue (10%), hearing impairment (10%), and hyperglycemia (8%). Teprotumumab is contraindicated for those with inflammatory bowel disease and who are pregnant. Although the current dosing regimen has proven effective for TED, dose-ranging studies including variable concentrations, infusion frequencies, and durations of teprotumumab therapy in the setting of TED have not been performed.
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Affiliation(s)
- Bryan J Winn
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California.
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
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Peiffert M, Cugnet-Anceau C, Dalle S, Chikh K, Assaad S, Disse E, Raverot G, Borson-Chazot F, Abeillon-du Payrat J. Graves' Disease during Immune Checkpoint Inhibitor Therapy (A Case Series and Literature Review). Cancers (Basel) 2021; 13:cancers13081944. [PMID: 33920721 PMCID: PMC8073133 DOI: 10.3390/cancers13081944] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 02/08/2023] Open
Abstract
Thyrotoxicosis is an adverse event associated with immune checkpoint inhibitors (ICPis) that occurs in 0.6 to 3.2% of treated patients, depending on ICPi class. Presentation usually consists of a biphasic thyroiditis with transient thyrotoxicosis and secondary hypothyroidism. ICPi-induced Graves' disease (GD), due to the stimulating activity of TSH-receptor autoantibodies (TRAb), is extremely rare. The aim of this retrospective study was to describe the characteristics and evolution of GD during ICPi therapy. Five among 243 patients followed for ICPi-induced thyrotoxicosis showed TRAb positivity (2% of the cohort). GD occurred quickly after initiation of ICPis; its course was typical for two patients, with prolonged requirement for antithyroid drug treatment (ATD). The three other patients experienced biphasic thyroiditis with secondary hypothyroidism requiring long-term substitution. Three other patients had a diagnosis of GD before starting ICPis; they evolved toward hypothyroidism with early cessation of ATD and long-term substitution treatment during ICPi treatment. None developed significant Graves' orbitopathy. ICPi treatment was not interrupted for thyroid dysfunction. In conclusion, GD is a rare, immune-related adverse event of ICPis with an unusual course and frequent evolution to biphasic thyroiditis. In the case of ICPi-induced thyrotoxicosis in the presence of TRAb, observing the spontaneous evolution and performing a scintigraphy are useful before starting ATD treatment. Pre-existing GD is not exacerbated by ICPis and tends to evolve towards hypothyroidism. ICPi treatment can be maintained with adequate biochemical surveillance.
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Affiliation(s)
- Mathilde Peiffert
- Faculté de Médecine, Université Lyon 1, 69008 Lyon, France; (S.D.); (K.C.); (E.D.); (G.R.); (F.B.-C.)
- Fédération d’Endocrinologie, Hôpital Louis Pradel, Groupement Hospitalier Est, Hospices Civils de Lyon, 69500 Bron, France
- Correspondence: (M.P.); (J.A.-d.P.); Tel.: +33-4-27-85-66-66 (J.A.-d.P.)
| | - Christine Cugnet-Anceau
- Service d’Endocrinologie-Diabète-Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France;
- ImmuCare, Institut de Cancérologie, Hospices Civils de Lyon, 69002 Lyon, France
| | - Stephane Dalle
- Faculté de Médecine, Université Lyon 1, 69008 Lyon, France; (S.D.); (K.C.); (E.D.); (G.R.); (F.B.-C.)
- ImmuCare, Institut de Cancérologie, Hospices Civils de Lyon, 69002 Lyon, France
- Service de Dermatologie, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Karim Chikh
- Faculté de Médecine, Université Lyon 1, 69008 Lyon, France; (S.D.); (K.C.); (E.D.); (G.R.); (F.B.-C.)
- Centre de Biologie Sud, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Souad Assaad
- Tox’imm, Centre Léon Bérard, 69008 Lyon, France;
- Service d’Hématologie et Médecine Interne, Centre Léon Berard, 69008 Lyon, France
| | - Emmanuel Disse
- Faculté de Médecine, Université Lyon 1, 69008 Lyon, France; (S.D.); (K.C.); (E.D.); (G.R.); (F.B.-C.)
- Service d’Endocrinologie-Diabète-Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France;
- INSERM U1060, INRA 1397, INSA Lyon, Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH RA), CarMeN Laboratory, 69310 Pierre-Bénite, France
| | - Gérald Raverot
- Faculté de Médecine, Université Lyon 1, 69008 Lyon, France; (S.D.); (K.C.); (E.D.); (G.R.); (F.B.-C.)
- Fédération d’Endocrinologie, Hôpital Louis Pradel, Groupement Hospitalier Est, Hospices Civils de Lyon, 69500 Bron, France
- INSERM U1052, CNRS, UMR5286, Cancer Research Center of Lyon, 69008 Lyon, France
| | - Françoise Borson-Chazot
- Faculté de Médecine, Université Lyon 1, 69008 Lyon, France; (S.D.); (K.C.); (E.D.); (G.R.); (F.B.-C.)
- Fédération d’Endocrinologie, Hôpital Louis Pradel, Groupement Hospitalier Est, Hospices Civils de Lyon, 69500 Bron, France
| | - Juliette Abeillon-du Payrat
- Fédération d’Endocrinologie, Hôpital Louis Pradel, Groupement Hospitalier Est, Hospices Civils de Lyon, 69500 Bron, France
- ImmuCare, Institut de Cancérologie, Hospices Civils de Lyon, 69002 Lyon, France
- Correspondence: (M.P.); (J.A.-d.P.); Tel.: +33-4-27-85-66-66 (J.A.-d.P.)
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Assessment of Orbital Computed Tomography (CT) Imaging Biomarkers in Patients with Thyroid Eye Disease. J Digit Imaging 2021; 32:987-994. [PMID: 31197558 DOI: 10.1007/s10278-019-00195-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
To understand potential orbital biomarkers generated from computed tomography (CT) imaging in patients with thyroid eye disease. This is a retrospective cohort study. From a database of an ongoing thyroid eye disease research study at our institution, we identified 85 subjects who had both clinical examination and laboratory records supporting the diagnosis of thyroid eye disease and concurrent imaging prior to any medical or surgical intervention. Patients were excluded if imaging quality or type was not amenable to segmentation. The images of 170 orbits were analyzed with the developed automated segmentation tool. The main outcome measure was to cross 25 CT structural metrics for each eye with nine clinical markers using a Kendall rank correlation test to identify significant relationships. The Kendall rank correlation test between automatically calculated CT metrics and clinical data demonstrated numerous correlations. Extraocular rectus muscle metrics, such as the average diameter of the superior, medial, and lateral rectus muscles, showed a strong correlation (p < 0.05) with loss of visual acuity and presence of ocular motility defects. Hertel measurements demonstrated a strong correlation (p < 0.05) with volumetric measurements of the optic nerve and other orbital metrics such as the crowding index and proptosis. Optic neuropathy was strongly correlated (p < 0.05) with an increase in the maximum diameter of the superior muscle. This novel method of automated imaging metrics may provide objective, rapid clinical information. This data may be useful for appreciation of severity of thyroid eye disease and recognition of risk factors of visual impairment from dysthyroid optic neuropathy from CT imaging.
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Denisova K, Barmettler A. Evaluating the Thyroid Eye Disease Patient. Int Ophthalmol Clin 2021; 61:33-52. [PMID: 33743527 DOI: 10.1097/iio.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Zhang M, Ding X, Wu LP, He MQ, Chen ZY, Shi BY, Wang Y. A Promising Mouse Model of Graves' Orbitopathy Induced by Adenovirus Expressing Thyrotropin Receptor A Subunit. Thyroid 2021; 31:638-648. [PMID: 33076782 DOI: 10.1089/thy.2020.0088] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Graves' orbitopathy (GO) is the most common and serious manifestation of Graves' disease (GD). It is characterized by orbital inflammation and tissue remodeling. Although several GO models have been reported, most lack a full assessment or mechanistic evaluation. Here, we established a promising mouse model mimicking many aspects of human GO with a frequency of 70% and characterized the key role of T cells in the progression of GO. Methods: An adenovirus expressing the human thyrotropin (TSH) receptor A subunit (Ad-TSHRA) was injected in the muscles of female BALB/C mice nine times to induce GO. At predetermined time points, histological examinations of retrobulbar tissues and thyroid glands were performed to dynamically monitor changes; serum autoantibodies and total thyroxine levels were examined to evaluate thyroid function. Flow cytometry of CD4+ T cell subgroups and RNA sequencing (RNA-Seq) of splenocytes were also performed to explore the underlying mechanism. Results: After nine injections, 7 of 10 mice challenged with Ad-TSHRA developed the orbital changes associated with GO. Seven mice manifested retrobulbar fibrosis, and four mice showed adipogenesis. Exophthalmia, conjunctival redness, and orbital lymphocyte infiltration were also observed in a subset of mice. The orbitopathy was first detected after seven injections and followed the hyperplastic change observed in thyroids after four injections. Flow cytometry revealed increased proportions of Th1 cells and decreased proportions of Th2 cells and regulatory T (Treg) cells in the splenocytes of GO mice. This change in CD4+ T cell subgroups was confirmed by orbital immunohistochemical staining. Genes involved in T cell receptor signaling, proliferation, adhesion, inflammation, and cytotoxicity were upregulated in GO mice according to the RNA-Seq; a trend of upregulation of these GO-specific genes was observed in mice with hyperthyroidism without orbitopathy after four injections. Conclusions: A GO mouse model was successfully established by administering nine injections of Ad-TSHRA. The model was achieved with a frequency of 70% and revealed the importance of T cell immunity. A potential time window from Graves' hyperthyroidism to GO was presented for the first time. Therefore, this model could be used to study the pathogenesis and novel treatments for GO.
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Affiliation(s)
- Meng Zhang
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xi Ding
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li-Ping Wu
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ming-Qian He
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zi-Yi Chen
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bing-Yin Shi
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yue Wang
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Jain AP, Jaru-Ampornpan P, Douglas RS. Thyroid eye disease: Redefining its management-A review. Clin Exp Ophthalmol 2021; 49:203-211. [PMID: 33484076 DOI: 10.1111/ceo.13899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/03/2020] [Accepted: 12/18/2020] [Indexed: 12/27/2022]
Abstract
Thyroid eye disease (TED) is a debilitating, vision threatening disease that dramatically alters patients' quality of life. Until recently, the management of TED is a long arduous course with supportive therapy, followed by an extensive surgical treatment plan to reverse the disease endpoints. Teprotumumab offers an early, safe therapeutic intervention to help reverse disease end points such as diplopia and proptosis and improve quality of life.
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Affiliation(s)
- Amy P Jain
- Ophthalmology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Raymond S Douglas
- Ophthalmology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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