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Шеремета МС, Бессмертная ЕГ, Елфимова АР, Бабаева ДМ, Беловалова ИМ, Свириденко НЮ. [Clinical and immunological predictors of Graves' orbitopathy after radioiodine therapy of Graves' disease]. PROBLEMY ENDOKRINOLOGII 2023; 69:16-24. [PMID: 37968948 PMCID: PMC10680543 DOI: 10.14341/probl13293] [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: 04/08/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Data on the effect of 131I on the course of Graves' orbitopathy (GO) are contradictory. A number of studies indicate a deterioration in the course of GO against the background of RAIT, in other studies such a connection has not been established. Cytokines that regulate inflammation could potentially be biomarkers for assessing GO activity and predicting the course of GO after RAIT. AIM The purpose of this study was to evaluate the dynamics of eye symptoms and analyze immunological parameters: cytokine TGF-β1 and cytokine receptors: sTNFα-R1, sTNFα-R2, sIL-2R, sIL-6R over time after RAIT, as possible predictors of GO activation. MATERIALS AND METHODS The study included 59 patients (118 orbits) with GD in the state of euthyroidism and subclinical hyperthyroidism and low active and inactive GO, aimed at conducting RAIT. Concentrations of cytokine TGF-β1, sTNFα-RI and sTNFα-R2, sIL-2R, sIL-6R, TSH receptor antibodies (rTSH-Ab), free thyroxine (FT4) and free triiodothyronine (FT3), -thyroid-stimulating hormone (TSH) in the blood serum were determined. Ultrasound examination of the thyroid gland, multispiral computed tomography (MSCT)/magnetic resonance imaging (MRI) of the orbits was performed. The examination was carried out 3, 6, 12 months after the RAIT. RESULTS The deterioration of the course of the GO (1-2 points according to CAS) was noted after 3 months. (32.5%) and to a lesser degree after 6 and 12 months (13.2% and 8.45%, respectively). Dynamics were not noted, approximately, in the same number of patients (40.5%, 41.5%, 45.8%, respectively). An improvement in the course of the GO was noted after 6 and 12 months (45.3, 45.8, respectively). After 3 and 6 months, the achievement of hypothyroidism and a significant increase in the level of rTSH-Ab were noted. In the analysis of cytokines and their receptors a significant decrease in the level of TGF-β1 was noted after 3, 6 and 12 months. There was also a significant decrease in sTNF-R1 and sIL-2R at 3 and 6 months. The level of sTNFα-R2 significantly decreased 3 months after RAIT. The level of sIL-6R has not changed significantly. After 3 months in patients with positive dynamics of image intensification, the level of TGF-β1 did not significantly change compared with the level before RAIT, in patients with worsening of the course of GO or without dynamics, the level of TGF-β1 significantly decreased. After 6 months, there was the same trend, not reaching statistical significance. The IgG4 level and the IgG4/IgG ratio increased to 6 and 12 months, which corresponded to an increase in diplopia index. CONCLUSION The main limiting factor in the conduct of RAIT is the activity of the autoimmune process in the orbits. Since patients with inactive (CAS 0-2) or low activity (CAS 3-4) GO were referred for RAIT, there was no pronounced activation of GO after RAIT. There was a slight deterioration in the course of GO by only 1-2 points according to CAS after 3 months. (32.5%) and to a lesser degree after 6 months (13.2%). In the study, it was found that the main predictors of the deterioration of the course of GO after RAIT are uncompensated hypothyroidism, a high level of rTSH-Ab and a decrease in the level of cytokine TGF-β1.
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Affiliation(s)
- М. С. Шеремета
- Научный медицинский исследовательский центр эндокринологии
| | | | - А. Р. Елфимова
- Научный медицинский исследовательский центр эндокринологии
| | - Д. М. Бабаева
- Научный медицинский исследовательский центр эндокринологии
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Medalle II RSS, Miguel RTD. The thyroid eye disease (TED) laterality debate: A comparison of characteristics, presentation, severity, and activity, between unilateral and bilateral thyroid eye disease. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2021.100892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Sviridenko NY, Sheremeta MS, Belovalova IM, Melnichenko GA. [Treatment of Graves' disease in patients with thyroid eye disease]. Vestn Oftalmol 2021; 137:128-135. [PMID: 34965078 DOI: 10.17116/oftalma2021137061128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Graves' disease (GD) is an autoimmune disease that is often complicated by thyroid eye disease (TED). Clinical presentations of TED can develop simultaneously with the manifestation of GD, after the manifestation of GD amid treatment, and before the development of thyrotoxicosis. Treatment of such patients is a difficult task, because on the one hand, it is necessary to take into account the clinical picture of thyrotoxicosis, and on the other - the symptoms of eye damage. The combination of the two pathologies determines the need for simultaneous treatment of GD and TED, and the choice of a treatment method for GD will depend on the manifestations of TED. This article presents current views on the treatment of GD with concomitant TED. The choice of GD treatment method will be largely determined by the clinical manifestations of TED and will be conducted jointly by endocrinologists and ophthalmologists.
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Affiliation(s)
- N Yu Sviridenko
- Scientific Medical Research Center of Endocrinology, Moscow, Russia
| | - M S Sheremeta
- Scientific Medical Research Center of Endocrinology, Moscow, Russia
| | - I M Belovalova
- Scientific Medical Research Center of Endocrinology, Moscow, Russia
| | - G A Melnichenko
- Scientific Medical Research Center of Endocrinology, Moscow, Russia
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Affiliation(s)
- Santosh G Honavar
- Editor, Indian Journal of Ophthalmology, Centre for Sight, Hyderabad, Telangana, India
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Low- vs. high-dose radiotherapy in Graves' ophthalmopathy: a retrospective comparison of long-term results. Strahlenther Onkol 2021; 197:885-894. [PMID: 33860819 PMCID: PMC8458186 DOI: 10.1007/s00066-021-01770-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/16/2021] [Indexed: 11/22/2022]
Abstract
Purpose Radiotherapy represents an effective treatment option in Graves’ ophthalmopathy (GO), leading to palliation of clinical symptoms. However, there are only a limited number of trials comparing the effectiveness of low- vs. high-dose radiotherapy. Methods We analyzed 127 patients treated with radiotherapy for stage 3/4 GO (NOSPECS classification). Patients were treated with single doses of 2.0 Gy (cumulative dose 20 Gy) until 2007, afterwards a single dose of 0.8 Gy (cumulative dose 4.8 Gy) was applied. With a median follow-up-time of 9.0 years, the treatment efficacy (overall improvement, sense of eye pressure, lid edema, ocular motility, exophthalmos, subjective vision, and diplopia) and adverse effects were analyzed by a standardized survey. Results Overall, 63.8% described improvement of symptoms after radiotherapy. No significant differences in overall treatment response and improvement of main outcome measures between low- or high-dose radiotherapy treatments are detectable, while low-dose radiotherapy leads significantly more often to retreatment (13.1% vs. 1.7%, p = 0.016). The main independent predictor of treatment response is the presence of lid edema (odds ratio, OR, 3.53; p = 0.006). Conclusion At long-term follow-up, the majority of patients reported palliation of symptoms with limited adverse effects, suggesting clinical effectiveness of radiotherapy for amelioration of GO symptoms independent of low- or high-dose radiotherapy.
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Glucocorticoids for Thyroid Eye Disease. Int Ophthalmol Clin 2021; 61:63-78. [PMID: 33743529 DOI: 10.1097/iio.0000000000000357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chua AW, Kumar CM, Chua MJ, Harrisberg BP. Anaesthesia for ophthalmic procedures in patients with thyroid eye disease. Anaesth Intensive Care 2020; 48:430-438. [PMID: 33198476 DOI: 10.1177/0310057x20957018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thyroid eye disease is an autoimmune inflammatory disorder of the orbit in adults. It causes inflammation, expansion and fibrosis of orbital fat, muscles and the lacrimal gland, leading to facial disfigurement, functional disability and, in severe cases, blindness. Overall, approximately 20% of affected patients need some form of surgical intervention requiring anaesthesia. This narrative review explores the background of thyroid eye disease, surgical procedures performed and their implications for anaesthesia. General anaesthesia is used for orbital decompression procedures, strabismus correction surgery and complex oculoplastic procedures. Local anaesthetic infiltration or regional anaesthesia under monitored anaesthesia care are the techniques most commonly employed for eyelid retraction surgery. It is important to limit the volume of local anaesthetic agent used during infiltration and continuously monitor the orbital volume and ocular pressure with a ballottement technique. In addition, the contralateral eye should be checked and, if necessary, protected against corneal exposure. Retrobulbar, peribulbar and sub-Tenon's blocks are best avoided. Topical anaesthesia has been used for some strabismus correction surgery but its use is limited to motivated and cooperative patients only.
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Affiliation(s)
- Alfred Wy Chua
- Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Chandra M Kumar
- Department of Anaesthetics, Khoo Teck Puat Hospital, Singapore.,Newcastle University, Newcastle upon Tyne, UK.,Newcastle University Medical School, Johor, Malaysia
| | - Matthew J Chua
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, Australia
| | - Brian P Harrisberg
- Department of Ophthalmology, Royal Prince Alfred Hospital, Camperdown, Australia
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Wu CM, Liao HE, Hsu SW, Lan SJ. Cervicogenic exophthalmos: Possible etiology and pathogenesis. World J Clin Cases 2020; 8:318-324. [PMID: 32047780 PMCID: PMC7000940 DOI: 10.12998/wjcc.v8.i2.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/17/2019] [Accepted: 12/22/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Unilateral exophthalmos is often caused by inflammation, neoplasm, infection, metabolic disease, vascular disorder and several other less common conditions. Reflex sympathetic dystrophy related to unilateral exophthalmos has not been reported in the past literature.
CASE SUMMARY We describe a 45-year-old female with unilateral exophthalmos caused by reflex sympathetic dystrophy and its unexpected spontaneous disappearance after a standard anterior cervical discectomy and fixation operation with two PEEK interbody cages and a plate. To our surprise, the patient’s left unilateral exophthalmos improved spontaneously in the morning on postoperative day 2-with no relapse, without any further medication, as of seven years. We have named this condition “cervicogenic exophthalmos.”
CONCLUSION We would inform other clinicians that unilateral exophthalmos was caused not only by inflammation, vascular disorder, infection, neoplasm, or metabolic disease, but also by reflex sympathetic dystrophy related with cervicogenic spondylosis. To the best of our knowledge, ours is the first related case report and use of the term “cervicogenic exophthalmos” after reviewing previous literature.
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Affiliation(s)
- Chi-Ming Wu
- Orthopaedic Department, Jen-Ai Hospital, Taichung 40041, Taiwan
- Orthopaedic Department, National Defense Medical Center, Taipei 11465, Taiwan
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
| | - Hung-En Liao
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
| | - Shang-Wei Hsu
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
| | - Shou-Jen Lan
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan
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Abstract
BACKGROUND Thyroid eye disease (TED) is an autoimmune disorder that constitutes a major clinical and therapeutic challenge. Current treatment options for moderate-to-severe TED include immunotherapy, orbital radiotherapy and decompression surgery. Limited drugs of proven efficacy are available for the treatment of people with TED. Given the role in the pathogenesis of TED of interleukin (IL)-6 expression in adipocytes, fibroblasts and macrophages, the proposed theory is that inhibition of IL-6 by tocilizumab may be an effective treatment in TED by directly reducing the inflammatory response. In addition, there is an unmet need for a new treatment that can modify the natural course of the disease and reduce the incidence of late complications that can occur as a result of fibrosis following inflammation. OBJECTIVES To investigate the efficacy and harms of tocilizumab for the treatment of people with TED. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 6); MEDLINE Ovid; Embase Ovid; LILACS BIREME; OpenGrey; the ISRCTN registry; ClinicalTrials.gov; the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and the EU Clinical Trials Register. The date of the search was 31 July 2018. SELECTION CRITERIA We searched for trials of tocilizumab administered by intravenous infusion using any dosage regimen, compared with placebo or intravenous glucocorticoid therapy for people with TED. DATA COLLECTION AND ANALYSIS We planned to use standard methods recommended by Cochrane. The primary outcome was change in TED score (as defined by investigators). Secondary outcomes included measurement of the following parameters: change in proptosis, change in extraocular motility, change in palpebral aperture measurements, number of relapses, development of optic neuropathy and change in quality of life score. We planned to measure these outcomes at three months (range two to six months) and 12 months (range six to 18 months) post-treatment. Adverse outcomes included any adverse effects identified in the trials at any time point. MAIN RESULTS No studies met the inclusion criteria of this review. We found one randomised, placebo-controlled, double masked study (NCT01297699). This study plans to evaluate the efficacy and harms of tocilizumab administration in people with moderate-to-severe or sight-threatening graves' ophthalmopathy (GO), that had not responded adequately to treatment with intravenous corticosteroid pulses. It was completed in December 2015 and will be assessed for inclusion in the review when data become available. AUTHORS' CONCLUSIONS There is currently no evidence from randomised controlled trials evaluating the efficacy and harms of tocilizumab for the treatment of people with TED.
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Affiliation(s)
- Shirin Hamed Azzam
- Moorfields Eye Hospital NHS Foundation Trust162 City RoadLondonUKEC1V 2PD
| | - Swan Kang
- Moorfields Eye Hospital NHS Foundation Trust162 City RoadLondonUKEC1V 2PD
| | | | - Daniel G Ezra
- Moorfields Eye Hospital NHS Foundation TrustMoorfields and UCL Institute of Ophthalmology BMRCCity RoadLondonUKEC1V 2PD
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Hamed Azzam S, Kang S, Salvi M, Ezra DG. Tocilizumab for thyroid eye disease. Hippokratia 2018. [DOI: 10.1002/14651858.cd012984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shirin Hamed Azzam
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK EC1V 2PD
| | - Swan Kang
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK EC1V 2PD
| | | | - Daniel G Ezra
- Moorfields Eye Hospital NHS Foundation Trust; Moorfields and UCL Institute of Ophthalmology BMRC; City Road London UK EC1V 2PD
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Sarcoidosis in the Head and Neck: An Illustrative Review of Clinical Presentations and Imaging Findings. AJR Am J Roentgenol 2017; 208:66-75. [DOI: 10.2214/ajr.16.16058] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Thatcher J, Chang YM, Chapman MN, Hovis K, Fujita A, Sobel R, Sakai O. Clinical-Radiologic Correlation of Extraocular Eye Movement Disorders: Seeing beneath the Surface. Radiographics 2016; 36:2123-2139. [PMID: 27831838 DOI: 10.1148/rg.2016150227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Extraocular eye movement disorders are relatively common and may be a significant source of discomfort and morbidity for patients. The presence of restricted eye movement can be detected clinically with quick, easily performed, noninvasive maneuvers that assess medial, lateral, upward, and downward gaze. However, detecting the presence of ocular dysmotility may not be sufficient to pinpoint the exact cause of eye restriction. Imaging plays an important role in excluding, in some cases, and detecting, in others, a specific cause responsible for the clinical presentation. However, the radiologist should be aware that the imaging findings in many of these conditions when taken in isolation from the clinical history and symptoms are often nonspecific. Normal eye movements are directly controlled by the ocular motor cranial nerves (CN III, IV, and VI) in coordination with indirect input or sensory stimuli derived from other cranial nerves. Specific causes of ocular dysmotility can be localized to the cranial nerve nuclei in the brainstem, the cranial nerve pathways in the peripheral nervous system, and the extraocular muscles in the orbit, with disease at any of these sites manifesting clinically as an eye movement disorder. A thorough understanding of central nervous system anatomy, cranial nerve pathways, and orbital anatomy, as well as familiarity with patterns of eye movement restriction, are necessary for accurate detection of radiologic abnormalities that support a diagnostic source of the suspected extraocular movement disorder. ©RSNA, 2016.
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Affiliation(s)
- Joshua Thatcher
- From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.)
| | - Yu-Ming Chang
- From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.)
| | - Margaret N Chapman
- From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.)
| | - Keegan Hovis
- From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.)
| | - Akifumi Fujita
- From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.)
| | - Rachel Sobel
- From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.)
| | - Osamu Sakai
- From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.)
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Liu X, Wang S, Qin L, Qiang W, Dahal M, Fan P, Gao S, Shi B. Short and long-term effects of high-dose intravenous methylprednisolone pulse therapy on thyroid-associated ophthalmopathy. Exp Ther Med 2016; 12:901-908. [PMID: 27446294 PMCID: PMC4950155 DOI: 10.3892/etm.2016.3446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/07/2016] [Indexed: 12/30/2022] Open
Abstract
The majority of previous studies on high-dose intravenous methylprednisolone pulse (IVMP) therapy have observed the clinical conditions of patients prior to and following treatment without any long-term follow-up, and these studies have predominantly focused on combined treatment. The present prospective clinical study aimed to assess the long-term effects and safety of high-dose IVMP therapy in thyroid-associated ophthalmopathy (TAO), as well as the significance of thyrotropin receptor antibody (TRAb) and soluble intercellular adhesion molecule-l (sICAM-1) during IVMP therapy. A total of 58 patients with TAO were treated with high-dose IVMP therapy, and their clinical characteristics and indices were recorded before, during and after therapy, with a 12-57 month (mean, 28.4 months) follow-up. Before treatment and on the second day after each IVMP therapy, serum TRAb and sICAM-1 levels were evaluated in 23 patients with TAO via a competitive radioimmunoassay and enzyme-linked immunosorbent assay, respectively. The results of the present study demonstrated that the symptoms of eyelid swelling, ophthalmodynia, photophobia, lacrimation and diplopia, and visual acuity, ocular motility, proptosis and clinical activity score (CAS) indices were all significantly improved after IVMP therapy. In addition, analysis of covariance demonstrated that alterations in the levels of serum TRAb during the course of treatment were associated with CAS of TAO, whereas the change in serum sICAM-1 was not. In conclusion, high-dose IVMP therapy is an effective, safe, stable and well-tolerated treatment for TAO, which is associated with rare, minor adverse effects. Furthermore, serum TRAb levels are correlated with the CAS of TAO and may serve as a predictor of the response to methylprednisolone therapy.
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Affiliation(s)
- Xiaomei Liu
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China; Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Shu Wang
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Li Qin
- Department of Ophthalmology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Wei Qiang
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Mahesh Dahal
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Ping Fan
- Department of Rheumatism, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Shan Gao
- Department of Endocrinology, Shaanxi Provincial People's Hospital Affiliated to Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Bingyin Shi
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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Chaudhry IA. Update in oculoplastic imaging. Saudi J Ophthalmol 2012; 26:347-8. [DOI: 10.1016/j.sjopt.2012.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 11/03/2012] [Indexed: 10/27/2022] Open
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Chaudhry IA. Thyroid associated orbitopathy: Understanding pathophysiology. Saudi J Ophthalmol 2011; 25:1-2. [DOI: 10.1016/j.sjopt.2010.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 11/01/2010] [Indexed: 10/18/2022] Open
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