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Amer R, Koriat A. Aqueous humor perturbations in chronic smokers: a proteomic study. Sci Rep 2024; 14:11279. [PMID: 38760463 PMCID: PMC11101467 DOI: 10.1038/s41598-024-62039-6] [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: 08/21/2023] [Accepted: 05/13/2024] [Indexed: 05/19/2024] Open
Abstract
The detrimental effects of smoking are multisystemic and its effects on the eye health are significant. Smoking is a strong risk factor for age-related nuclear cataract, age-related macular degeneration, glaucoma, delayed corneal epithelial healing and increased risk of cystoid macular edema in patients with intermediate uveitis among others. We aimed to characterize the aqueous humor (AH) proteome in chronic smokers to gain insight into its perturbations and to identify potential biomarkers for smoking-associated ocular pathologies. Compared to the control group, chronic smokers displayed 67 (37 upregulated, 30 downregulated) differentially expressed proteins (DEPs). Analysis of DEPs from the biological point of view revealed that they were proteins involved in complement activation, lymphocyte mediated immunity, innate immune response, cellular oxidant detoxification, bicarbonate transport and platelet degranulation. From the molecular function point of view, DEPs were involved in oxygen binding, oxygen carrier activity, hemoglobin binding, peptidase/endopeptidase/cysteine-type endopeptidase inhibitory activity. Several of the upregulated proteins were acute phase reactant proteins such as clusterin, alpha-2-HS-glycoprotein, fibrinogen, alpha-1-antitrypsin, C4b-binding protein and serum amyloid A-2. Further research should confirm if these proteins might serve as biomarkers or therapeutic target for smoking-associated ocular diseases.
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Affiliation(s)
- Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel.
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Adi Koriat
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
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2
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Buonfiglio F, Ponto KA, Pfeiffer N, Kahaly GJ, Gericke A. Redox mechanisms in autoimmune thyroid eye disease. Autoimmun Rev 2024; 23:103534. [PMID: 38527685 DOI: 10.1016/j.autrev.2024.103534] [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: 01/12/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 03/27/2024]
Abstract
Thyroid eye disease (TED) is an autoimmune condition affecting the orbit and the eye with its adnexa, often occurring as an extrathyroidal complication of Graves' disease (GD). Orbital inflammatory infiltration and the stimulation of orbital fibroblasts, triggering de novo adipogenesis, an overproduction of hyaluronan, myofibroblast differentiation, and eventual tissue fibrosis are hallmarks of the disease. Notably, several redox signaling pathways have been shown to intensify inflammation and to promote adipogenesis, myofibroblast differentiation, and fibrogenesis by upregulating potent cytokines, such as interleukin (IL)-1β, IL-6, and transforming growth factor (TGF)-β. While existing treatment options can manage symptoms and potentially halt disease progression, they come with drawbacks such as relapses, side effects, and chronic adverse effects on the optic nerve. Currently, several studies shed light on the pathogenetic contributions of emerging factors within immunological cascades and chronic oxidative stress. This review article provides an overview on the latest advancements in understanding the pathophysiology of TED, with a special focus of the interplay between oxidative stress, immunological mechanisms and environmental factors. Furthermore, cutting-edge therapeutic approaches targeting redox mechanisms will be presented and discussed.
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Affiliation(s)
- Francesco Buonfiglio
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - Katharina A Ponto
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - George J Kahaly
- Medicine I (GJK), University Medical Center of the Johannes Gutenberg- University, Mainz, Germany.
| | - Adrian Gericke
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
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Lee C, Park JW, Kim YD, Woo KI. Efficacy of tocilizumab in patients with moderate-to-severe corticosteroid-resistant thyroid eye disease: a prospective study. Int Ophthalmol 2024; 44:179. [PMID: 38622479 DOI: 10.1007/s10792-024-03117-6] [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: 12/16/2023] [Accepted: 03/24/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE To evaluate the clinical outcomes of intravenous tocilizumab (TCZ) injection in patients with moderate-to-severe active thyroid eye disease (TED). METHODS Patients with active and moderate-to-severe TED who did not respond to conventional therapies were treated with TCZ from June 2019 to January 2021. The medical records of the patients were evaluated before the treatment. We analyzed patient demographics, including the duration of Graves' disease and TED, and assessed subjective symptoms, such as diplopia and ocular movement, clinical activity score (CAS), modified NOSPECS score, and exophthalmos before treatment and at 4, 8, 12, and 16 weeks after the first drug injection. Blood tests, including TSH Rc Ab and TS Ab, were performed before treatment and 24 weeks after the first injection. And orbital computed tomography (CT) was performed and Barrett's Index was calculated at baseline and after completion of all injections. RESULTS Nineteen completed the scheduled treatment. There were no significant side effects, other than herpes zoster in one case and headache and dermatitis in another. Clinical symptoms before and 16 weeks after the treatment showed mean CAS decreased by 2.4 points, mean modified NOSPECS score decreased by 3.7 points, and mean exophthalmos decreased by 0.4 mm. Diplopia and extraocular muscle limitation improved in ten and remained stationary in five of the 15 patients, who presented with extraocular motility abnormalities. Six of 11 patients who underwent orbit CT showed improvement in muscle size. The mean TSH Rc Ab decreased by 7.5 IU/L and TS-Ab decreased by 162.9%. CONCLUSION TCZ can treat active moderate-to-severe TED, showing high drug compliance and reasonable response to inflammation and extraocular motility abnormality.
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Affiliation(s)
- Chaeyeon Lee
- Department of Ophthalmology, Samsung Medical Center, SungkyunkwanUniversitySchool of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Ji Woong Park
- Department of Ophthalmology, Seoul Eye Clinic, Anyang, South Korea
| | - Yoon-Duck Kim
- Department of Ophthalmology, Nune Eye Hospital, Seoul, South Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, SungkyunkwanUniversitySchool of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Oeverhaus M, Sander J, Smetana N, Bechrakis NE, Inga N, Al-Ghazzawi K, Chen Y, Eckstein A. How Age Affects Graves' Orbitopathy-A Tertiary Center Study. J Clin Med 2024; 13:290. [PMID: 38202297 PMCID: PMC10779662 DOI: 10.3390/jcm13010290] [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: 10/02/2023] [Revised: 11/08/2023] [Accepted: 11/29/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE Graves' orbitopathy (GO) is an autoimmune disorder leading to inflammation, adipogenesis, and fibrosis. The severity of GO can vary widely among individuals, making it challenging to predict the natural course of the disease accurately, which is important for tailoring the treatment approach to the individual patient. The aim of this study was to compare the clinical characteristics, course, treatment, and prognosis of GO patients under 50 years with older patients. METHODS We reviewed the medical records of a random sample of 1000 patients in our GO database Essen (GODE) comprising 4260 patients at our tertiary referral center. Patients were divided into two groups: Group 1 (≤50 years) and Group 2 (>50 years). Only patients with a complete data set were included in the further statistical analysis. RESULTS The results showed that younger patients (n = 484) presented significantly more often with mild GO (53% vs. 33%, p < 0.0001), while older patients (n = 448) were more likely to experience moderate-to-severe disease (44% vs. 64%, p < 0.0001). Older patients showed more severe strabismus, motility, and clinical activity scores (5.9 vs. 2.3 PD/310° vs. 330° both p < 0.0001, CAS: 2.1 vs. 1.7, p = 0.001). Proptosis and occurrence of dysthyroid optic neuropathy (DON) showed no significant difference between groups (both 3%). Multiple logistic regression revealed that the need for a second step of eye muscle surgery was most strongly associated with prior decompression (OR = 0.12, 95% CI: 0.1-0.2, p < 0.0001) followed by orbital irradiation and age. The model showed good fitness regarding the area under the curve (AUC = 0.83). DISCUSSION In conclusion, younger GO patients present with milder clinical features such as a lower rate of restrictive motility disorders and less pronounced inflammatory signs. Therefore, older patients tend to need more steroids, irradiation, and lid and eye muscle surgery. Still, the risk of DON and the necessity of secondary eye muscle surgery are not or only slightly associated with age, respectively.
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Affiliation(s)
- Michael Oeverhaus
- Department of Ophthalmology, University Hospital Essen, 45147 Essen, Germany
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Stuart KV, Madjedi KM, Luben RN, Biradar MI, Wagner SK, Warwick AN, Sun Z, Hysi PG, Simcoe MJ, Foster PJ, Khawaja AP. Smoking, Corneal Biomechanics, and Glaucoma: Results From Two Large Population-Based Cohorts. Invest Ophthalmol Vis Sci 2024; 65:11. [PMID: 38170539 PMCID: PMC10768714 DOI: 10.1167/iovs.65.1.11] [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: 10/06/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose Smoking may influence measured IOP through an effect on corneal biomechanics, but it is unclear whether this factor translates into an increased risk for glaucoma. This study aimed to examine the association of cigarette smoking with corneal biomechanical properties and glaucoma-related traits, and to probe potential causal effects using Mendelian randomization (MR). Methods Cross-sectional analyses within the UK Biobank (UKB) and Canadian Longitudinal Study on Aging (CLSA) cohorts. Multivariable linear and logistic regression models were used to assess associations of smoking (status, intensity, and duration) with corneal hysteresis (CH), corneal resistance factor, IOP, inner retinal thicknesses, and glaucoma. Two-sample MR analyses were performed. Results Overall, 68,738 UKB (mean age, 56.7 years; 54.7% women) and 22 845 CLSA (mean age, 62.7 years; 49.1% women) participants were included. Compared with nonsmokers, smokers had a higher CH (UKB, +0.48 mm Hg; CLSA, +0.57 mm Hg; P < 0.001) and corneal resistance factor (UKB, +0.47 mm Hg; CLSA, +0.60 mm Hg; P < 0.001) with evidence of a dose-response effect in both studies. Differential associations with Goldmann-correlated IOP (UKB, +0.25 mm Hg; CLSA, +0.36 mm Hg; P < 0.001) and corneal-compensated IOP (UKB, -0.28 mm Hg; CLSA, -0.32 mm Hg; P ≤ 0.001) were observed. Smoking was not associated with inner retinal thicknesses or glaucoma status in either study. MR provided evidence for a causal effect of smoking on corneal biomechanics, especially higher CH. Conclusions Cigarette smoking seems to increase corneal biomechanical resistance to deformation, but there was little evidence to support a relationship with glaucoma. This outcome may result in an artefactual association with measured IOP and could account for discordant results with glaucoma in previous epidemiological studies.
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Affiliation(s)
- Kelsey V. Stuart
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Kian M. Madjedi
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Department of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Robert N. Luben
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mahantesh I. Biradar
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Siegfried K. Wagner
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Alasdair N. Warwick
- UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Zihan Sun
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Pirro G. Hysi
- Department of Ophthalmology, St Thomas’ Hospital, King's College London, London, United Kingdom
- Department of Twin Research & Genetic Epidemiology, St Thomas’ Hospital, King's College London, London, United Kingdom
| | - Mark J. Simcoe
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Department of Ophthalmology, St Thomas’ Hospital, King's College London, London, United Kingdom
- Department of Twin Research & Genetic Epidemiology, St Thomas’ Hospital, King's College London, London, United Kingdom
| | - Paul J. Foster
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Anthony P. Khawaja
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - on behalf of the Modifiable Risk Factors for Glaucoma Collaboration and the UK Biobank Eye and Vision Consortium
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Department of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
- Department of Ophthalmology, St Thomas’ Hospital, King's College London, London, United Kingdom
- Department of Twin Research & Genetic Epidemiology, St Thomas’ Hospital, King's College London, London, United Kingdom
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Zhang Y, Zhang XJ, Yuan N, Wang YM, Ip P, Chen LJ, Tham CC, Pang CP, Yam JC. Secondhand smoke exposure and ocular health: A systematic review. Surv Ophthalmol 2023; 68:1166-1207. [PMID: 37479063 DOI: 10.1016/j.survophthal.2023.07.001] [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: 01/18/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
The toxicology of secondhand smoke (SHS), along with the harm of its exposure to human health, has been generally acknowledged; however, specific evidence is lacking on the association between SHS exposure and ocular health. In this systematic review (PROSPERO registration number: CRD42022247992), we included 55 original articles published by 12 May 2023, which dealt with SHS exposure and ocular disorders, such as eye irritation, conjunctivitis, dry eye diseases, uveitis, myopia, astigmatism, contact lens discomfort, age-related macular degeneration, glaucoma, and thyroid eye disease that addressed the ocular neurovascular structures of the macular, retinal nerve fiber layer, choroid, and corneal biomechanical parameters. We found compelling correlational evidence for eye irritation, conjunctivitis, and dry eye symptoms-supporting that SHS exposure was positively associated with inflammatory and allergic changes in the eyes. Yet, evidence about the associations between SHS exposure and other ocular disorders, structures, and parameters is still limited or controversial. Given the limitations of existing literature, more investigations with high quality and rigorous design are warranted to elucidate the potentially harmful effects of SHS exposure on ocular health.
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Affiliation(s)
- Youjuan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Joint Shantou International Eye Center, Shantou University, Shantou, China
| | - Nan Yuan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Kunming Bright Eye Hospital, Kunming, China
| | - Yu Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Neurobiology, Interdisciplinary Center for Neurosciences (IZN), Heidelberg University, Heidelberg, Germany
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Joint Shantou International Eye Center, Shantou University, Shantou, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Joint Shantou International Eye Center, Shantou University, Shantou, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China; Hong Kong Eye Hospital, Hong Kong SAR, China; Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong SAR, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Joint Shantou International Eye Center, Shantou University, Shantou, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Joint Shantou International Eye Center, Shantou University, Shantou, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China; Hong Kong Eye Hospital, Hong Kong SAR, China; Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong SAR, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Starčević A, Radojičić Z, Djurić Stefanović A, Trivić A, Milić I, Milić M, Matić D, Andrejic J, Djulejic V, Djoric I. Morphometric and volumetric analysis of lacrimal glands in patients with thyroid eye disease. Sci Rep 2023; 13:16345. [PMID: 37770536 PMCID: PMC10539510 DOI: 10.1038/s41598-023-43083-0] [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: 03/29/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
Assessment of morphometric and volumetric changes in lacrimal glands in thyroid eye disease, its clinical manifestations in relation of disease progression. Retrospective volumetric analysis included both genders and was performed on total of 183 patients - 91 patients with diagnosed Grave's disease and thyroid eye disease and 92 patients without Grave's disease and thyroid eye disease who underwent multidetector computed tomography (MDCT) examination in routine daily work according to other medical indications. In the group of females, there was statistical significance between patients with thyroid eye disease and controls who were smoking and had body weight gain. We found statistical significance in volumetric enlargements for both orbits in both genders for the patients group when compared to controls. There was also statistical significance in morphometric characteristics for the lacrimal gland diameters measured. Determination planimetric morphometric parameters of importance were coronary height of lacrimal gland of the right eye, coronary height of lacrimal gland of the left eye and coronary width of lacrimal gland of the left eye for the group of males. In a group of females the established determination parameters of importance were the coronary height of lacrimal gland of the left eye, the axial width of lacrimal gland of the left eye, volume of lacrimal gland of the right eye and the volume of lacrimal gland of the left eye. When we compared the displaced lacrimal gland coming forward (proptosis) in time progressing disease between group of patients and controls, we also found statistical significant connection. Evaluation of lacrimal gland volumetric and morphometric data may increase validity of defining this anatomical substrate and its morphology disruption as liable tool for thyroid eye disease progression follow up and treatment planning and outcome.
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Affiliation(s)
- Ana Starčević
- Laboratory for Multimodal Neuroimaging, Institute of Anatomy, Medical faculty, University of Belgrade, Belgrade, Serbia.
| | - Zoran Radojičić
- Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Djurić Stefanović
- Center for Radiology, University Clinical Center of Serbia, Medical faculty, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Trivić
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia, Medical faculty, University of Belgrade, Belgrade, Serbia
| | - Ivan Milić
- Clinic for Neurosurgery, University Clinical Center of Serbia, Medical faculty, University of Belgrade, Belgrade, Serbia
| | - Marina Milić
- Clinic for Neurosurgery, University Clinical Center of Serbia, Medical faculty, University of Belgrade, Belgrade, Serbia
| | - Dragan Matić
- Clinic for Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovana Andrejic
- Laboratory for Multimodal Neuroimaging, Institute of Anatomy, Medical faculty, University of Belgrade, Belgrade, Serbia
| | - Vuk Djulejic
- Laboratory for Multimodal Neuroimaging, Institute of Anatomy, Medical faculty, University of Belgrade, Belgrade, Serbia
| | - Igor Djoric
- Center for Radiology, Neurosurgery Clinic, University Clinical Center of Serbia, Medical faculty, University of Belgrade, Belgrade, Serbia
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Ramesh S, Zhang QE, Sharpe J, Penne R, Haller J, Lum F, Lee AY, Lee CS, Pershing S, Miller JW, Lorch A, Hyman L. Thyroid Eye Disease and its Vision-Threatening Manifestations in the Academy IRIS Registry: 2014-2018. Am J Ophthalmol 2023; 253:74-85. [PMID: 37201696 PMCID: PMC10525031 DOI: 10.1016/j.ajo.2023.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/31/2023] [Accepted: 04/17/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE To evaluate prevalence of thyroid eye disease (TED) and associated factors in the American Academy of Ophthalmology IRISⓇ Registry (Intelligent Research in Sight). DESIGN Cross-sectional analysis of the IRIS Registry. METHODS IRIS Registry patients (18-90 years old) were classified as TED (ICD-9: 242.00, ICD-10: E05.00 on ≥2 visits) or non-TED cases, and prevalence was estimated. Odds ratios (OR) and 95% Confidence Intervals (CIs) were estimated using logistic regression. RESULTS 41,211 TED patients were identified. TED prevalence was 0.09%, showed a unimodal age distribution (highest prevalence in ages 50-59 years (y) (0.12%)), higher rates in females than males (0.12% vs. 0.04%) and in non-Hispanics than Hispanics (0.10% vs. 0.05%). Prevalence differed by race (from 0.08% in Asians to 0.12% in Black/African-Americans), with varying peak ages of prevalence. Factors associated with TED in multivariate analysis included age: ((18-<30y (reference), 30-39y: OR (95%CI) 2.2 (2.0, 2.4), 40-49y: 2.9 (2.7,3.1), 50-59y: 3.3 (3.1, 3. 5), 60-69y: 2.7 (2.54, 2.85), 70+: 1.5 (1.46, 1.64)); female sex vs male (reference), 3.5 (3.4,3.6), race: White (reference), Blacks: 1.1 (1.1,1.2), Asian: 0.9 (0.8,0.9), Hispanic ethnicity vs not Hispanic (reference), 0.68 (0.6,0.7), smoking status: (never (ref), former: 1.64 (1.6,1.7), current 2.16: (2.1,2.2)) and Type 1 diabetes (yes vs no (reference): 1.87 (1.8, 1.9). CONCLUSIONS This epidemiologic profile of TED includes new observations such as a unimodal age distribution and racial variation in prevalence. Associations with female sex, smoking, and Type 1 diabetes are consistent with prior reports. These findings raise novel questions about TED in different populations.
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Affiliation(s)
- Sathyadeepak Ramesh
- From Department of Oculoplastics and Orbital Surgery, Wills Eye Hospital, Philadelphia, PA, USA (S.R, R.P); The Center for Eye and Facial Plastic Surgery, Somerset, NJ, USA (S.R)
| | - Qiang Ed Zhang
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, PA, USA (Q.Z, J.S, L.H); Wills Eye Hospital, Department of Ophthalmology, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, PA, USA (Q.Z, J.H, L.H)
| | - James Sharpe
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, PA, USA (Q.Z, J.S, L.H); Wills Eye Hospital, Department of Ophthalmology, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, PA, USA (Q.Z, J.H, L.H)
| | - Robert Penne
- From Department of Oculoplastics and Orbital Surgery, Wills Eye Hospital, Philadelphia, PA, USA (S.R, R.P)
| | - Julia Haller
- Wills Eye Hospital, Department of Ophthalmology, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, PA, USA (Q.Z, J.H, L.H)
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, CA, USA (F.L)
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA (A.Y.L, C.S.L); Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA (J.W.M, A.L)
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA (A.Y.L, C.S.L)
| | - Suzann Pershing
- Byers Eye Institute, Stanford University, and VA Palo Alto Health Care System, Palo Alto, CA, USA (S.P)
| | - Joan W Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA (J.W.M, A.L)
| | - Alice Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA (J.W.M, A.L)
| | - Leslie Hyman
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, PA, USA (Q.Z, J.S, L.H); Wills Eye Hospital, Department of Ophthalmology, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, PA, USA (Q.Z, J.H, L.H).
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9
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Cao F, Liu ZR, Ni QY, Zha CK, Zhang SJ, Lu JM, Xu YY, Tao LM, Jiang ZX, Pan HF. Emerging roles of air pollution and meteorological factors in autoimmune eye diseases. ENVIRONMENTAL RESEARCH 2023; 231:116116. [PMID: 37182831 DOI: 10.1016/j.envres.2023.116116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 05/16/2023]
Abstract
Autoimmune eye diseases (AEDs), a collection of autoimmune inflammatory ocular conditions resulting from the dysregulation of immune system at the ocular level, can target both intraocular and periorbital structures leading to severe visual deficit and blindness globally. The roles of air pollution and meteorological factors in the initiation and progression of AEDs have been increasingly attractive, among which the systemic and local mechanisms are both involved in. Exposure to excessive air pollution and extreme meteorological conditions including PM2.5/PM0.1, environmental tobacco smoke, insufficient sunshine, and high temperature, etc., can disturb Th17/Treg balance, regulate macrophage polarization, activate neutrophils, induce systemic inflammation and oxidative stress, decrease retinal blood flow, promote tissue fibrosis, activate sympathetic nervous system, adversely affect nutrients synthetization, as well as induce heat stress, therefore may together deteriorate AEDs. The crosstalk among inflammation, oxidative stress and dysregulated immune system appeared to be prominent. In the present review, we will concern and summarize the potential mechanisms underlying linkages of air pollution and meteorological factors to ocular autoimmune and inflammatory responses. Moreover, we concentrate on the specific roles of air pollutants and meteorological factors in several major AEDs including uveitis, Graves' ophthalmopathy (GO), ocular allergic disease (OAD), glaucoma, diabetic retinopathy (DR), etc.
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Affiliation(s)
- Fan Cao
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China; Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Zhuo-Ran Liu
- Department of Ophthalmology, Ningbo Hospital, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 1155 Binhaier Road, Ningbo, Zhejiang, China
| | - Qin-Yu Ni
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China; Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Chen-Kai Zha
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Shu-Jie Zhang
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Jia-Min Lu
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Yue-Yang Xu
- Department of Clinical Medicine, The First School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Li-Ming Tao
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China.
| | - Zheng-Xuan Jiang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China.
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China.
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10
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Takahashi Y, Vaidya A. Diagnosis and Management of Dysthyroid Optic Neuropathy. Int Ophthalmol Clin 2023; 63:233-248. [PMID: 37439621 DOI: 10.1097/iio.0000000000000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
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11
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Oeverhaus M, Winkler L, Stähr K, Daser A, Bechrakis N, Stöhr M, Chen Y, Eckstein A. Influence of biological sex, age and smoking on Graves’ orbitopathy – a ten-year tertiary referral center analysis. Front Endocrinol (Lausanne) 2023; 14:1160172. [PMID: 37082130 PMCID: PMC10110835 DOI: 10.3389/fendo.2023.1160172] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/22/2023] [Indexed: 04/07/2023] Open
Abstract
PurposeSeverity of Graves’ orbitopathy (GO) shows wide individual differences. For optimal treatment, it is important to be able to predict the natural course of the disease as accurate as possible to counteract with anti-inflammatory and surgical treatment. Therefore, we aimed to further elucidate the impact of sex, age and smoking on GO.MethodsWe collected the clinical and demographic data of all patients of our tertiary referral center from January 2008 till December 2018 and analyzed it with descriptive statistics. Only patients with a complete data set were included in the further analysis. Odds ratio’s for moderate-to-severe and sight-threatening GO in relation to age, sex and smoking were calculated by means of multivariate logistic regression models.ResultsWe evaluated the data of 4260 patient with GO and complete data sets. Most of these were women (83%). There were no significant differences between male and female patients regarding smoking habits and thyroid treatment. Men were significantly older at initial manifestation of TED (51.8 vs. 49.9y, p<0.01) and showed significant more often severe stages (61% vs. 53%, p<0.0001). Therefore, they needed significantly more intense treatment with steroids, irradiation, orbital decompression and muscle surgery. In multivariate logistic regression analyses age (OR 0.97, 95% CI:0.97-0.98, p<0.0001), male sex (OR 1.64, 95% CI:1.38-1.9, p<0.0001), smoking (OR 1.19, 95% CI:1.04-1.36, p=0.01), Grave’s disease (OR 1.55, 95% CI:1.26-1.90, p<0.0001) and history of radioiodine treatment (RAI) (OR 2.44, 95% CI:2.10-2.86, p<0.0001) showed an significant association with severe stages of GO.DiscussionOur retrospective analysis showed once more that women are more often afflicted by GO. In contrast, men seem to be more severely afflicted and in need of anti-inflammatory and surgical treatments. This might be due to a different approach to the health system and resilience to GO specific symptoms, as well as previously described worse thyroid control. Estrogen mediated effects might also play a role as in other autoimmune diseases and should be subject of further trials. Besides the biological sex, smoking could again be confirmed as serious risk factor for severe GO. Of note, RAI was associated with more severe stages of GO, which should be subject to further investigation.
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Affiliation(s)
- Michael Oeverhaus
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
- *Correspondence: Michael Oeverhaus,
| | - Luisa Winkler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - Kerstin Stähr
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Anke Daser
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | | | - Mareile Stöhr
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Ying Chen
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Anja Eckstein
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
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12
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Galor A, Britten-Jones AC, Feng Y, Ferrari G, Goldblum D, Gupta PK, Merayo-Lloves J, Na KS, Naroo SA, Nichols KK, Rocha EM, Tong L, Wang MTM, Craig JP. TFOS Lifestyle: Impact of lifestyle challenges on the ocular surface. Ocul Surf 2023; 28:262-303. [PMID: 37054911 DOI: 10.1016/j.jtos.2023.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.
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Affiliation(s)
- Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Surgical Services, Miami Veterans Administration, Miami, FL, USA.
| | - Alexis Ceecee Britten-Jones
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
| | - Yun Feng
- Department of Ophthalmology, Peking University Eye Center, Peking University Third Hospital, Beijing, China
| | - Giulio Ferrari
- Cornea and Ocular Surface Unit, Eye Repair Lab, San Raffaele Scientific Institute, Milan, Italy
| | - David Goldblum
- Pallas-Kliniken, Olten, Bern, Zurich, Switzerland; University of Basel, Basel, Switzerland
| | - Preeya K Gupta
- Triangle Eye Consultants, Raleigh, NC, USA; Department of Ophthalmology, Tulane University, New Orleans, LA, USA
| | - Jesus Merayo-Lloves
- Instituto Universitario Fernandez-Vega, Universidad de Oviedo, Principality of Asturias, Spain
| | - Kyung-Sun Na
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Kelly K Nichols
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eduardo M Rocha
- Department of Ophthalmology, Othorynolaringology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Center, Ocular Surface Research Group, Singapore Eye Research Institute, Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
| | - Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
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13
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Khamisi S, Lundqvist M, Engström BE, Larsson A, Karlsson FA, Ljunggren Ö. Comparison Between Thyroid Stimulating Immunoglobulin and TSH-Receptor Antibodies in the Management of Graves' Orbitopathy. Exp Clin Endocrinol Diabetes 2023; 131:236-241. [PMID: 36706788 PMCID: PMC10158629 DOI: 10.1055/a-2021-0596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES TSH-receptor antibodies (TRAb) targeting the TSH receptor (TSH-R) induce hyperthyroidism in Graves´ disease (GD). Graves´ orbitopathy (GO) is influenced by stimulation of the TSH-R in the orbita. GO has been, among other factors, linked to high TRAb levels. Thyroid stimulating immunoglobulins (TSI) is a relatively new method for assessing TSH-receptor antibodies. The aim of this study was to investigate the role of TSI in the management of GO. METHODS Patients with newly diagnosed GD (n=30, median age 55 years (range 35-72), 29 women) received pharmacological therapy (methimazole+++thyroxine) for up to 24 months. GO was identified by clinical signs and symptoms. Eleven patients had GO at diagnosis, and another six developed GO during treatment. Blood samples for TSI and other thyroidal biomarkers were obtained at baseline and on five occasions during the 24-month follow-up. Twenty-two subjects completed the drug regimen without surgery or radioiodine treatment. RESULTS At baseline, TSI was highly correlated with TRAb (r s =0.64, p<0.001), and both assays similarly correlated to fT3 values. TSI and TRAb did not differ significantly between GO and non-GO patients for visit v1 (n=30, 17 GO during the whole study) or at follow-up (n=22, 12 GO during the whole study). During follow-up, levels of TSI and TRAb decreased and normalized in both groups. CONCLUSION The present study does not support any added benefit of TSI compared to TRAb for the prediction and management of GO.
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Affiliation(s)
- Selwan Khamisi
- Department of Endocrinology and Diabetes, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Martin Lundqvist
- Department of Endocrinology and Diabetes, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Britt Edén Engström
- Department of Endocrinology and Diabetes, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - F Anders Karlsson
- Department of Endocrinology and Diabetes, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Östen Ljunggren
- Department of Endocrinology and Diabetes, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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14
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Thyroid Eye Disease. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122084. [PMID: 36556449 PMCID: PMC9787503 DOI: 10.3390/life12122084] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/01/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
Thyroid eye disease (TED), an autoimmune inflammatory disorder of the orbit, presents with a potential array of clinical sequelae. The pathophysiology behind TED has been partially characterized in the literature. There remain certain elusive mechanisms welcoming of research advances. Disease presentation can vary, but those that follow a characteristic course start mild and increase in severity before plateauing into an inactive phase. Diagnosis and evaluation include careful physical examination, targeted laboratory work up, appropriate imaging studies, and tailored treatment regimens. Special consideration may apply to certain populations, such as pediatric and pregnant patients.
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15
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Burch HB, Perros P, Bednarczuk T, Cooper DS, Dolman PJ, Leung AM, Mombaerts I, Salvi M, Stan MN. Management of Thyroid Eye Disease: A Consensus Statement by the American Thyroid Association and the European Thyroid Association. Thyroid 2022; 32:1439-1470. [PMID: 36480280 PMCID: PMC9807259 DOI: 10.1089/thy.2022.0251] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Thyroid eye disease (TED) remains challenging for clinicians to evaluate and manage. Novel therapies have recently emerged, and their specific roles are still being determined. Most patients with TED develop eye manifestations while being treated for hyperthyroidism and under the care of endocrinologists. Endocrinologists, therefore, have a key role in diagnosis, initial management, and selection of patients who require referral to specialist care. Given that the need for guidance to endocrinologists charged with meeting the needs of patients with TED transcends national borders, and to maximize an international exchange of knowledge and practices, the American Thyroid Association and European Thyroid Association joined forces to produce this consensus statement.
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Affiliation(s)
- Henry B. Burch
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Endocrinology Division, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Address correspondence to: Henry B. Burch, MD, National Institute of Diabetes and Digestive and Kidney Diseases, Division of Diabetes, Endocrinology, & Metabolic Diseases, National Institutes of Health, 6707 Democracy Blvd, Room 5053, Bethesda, MD 20892-0001, USA
| | - Petros Perros
- Department of Endocrinology, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - David S. Cooper
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter J. Dolman
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Angela M. Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Mario Salvi
- Department of Clinical and Community Services, Graves' Orbitopathy Center, Endocrinology, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Marius N. Stan
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, Minnesota, USA
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16
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Burch HB, Perros P, Bednarczuk T, Cooper DS, Dolman PJ, Leung AM, Mombaerts I, Salvi M, Stan MN. Management of thyroid eye disease: a Consensus Statement by the American Thyroid Association and the European Thyroid Association. Eur Thyroid J 2022; 11:e220189. [PMID: 36479875 PMCID: PMC9727317 DOI: 10.1530/etj-22-0189] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/30/2022] Open
Abstract
Thyroid eye disease (TED) remains challenging for clinicians to evaluate and manage. Novel therapies have recently emerged, and their specific roles are still being determined. Most patients with TED develop eye manifestations while being treated for hyperthyroidism and under the care of endocrinologists. Endocrinologists, therefore, have a key role in diagnosis, initial management, and selection of patients who require referral to specialist care. Given that the need for guidance to endocrinologists charged with meeting the needs of patients with TED transcends national borders, and to maximize an international exchange of knowledge and practices, the American Thyroid Association and European Thyroid Association joined forces to produce this Consensus Statement.
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Affiliation(s)
- Henry B Burch
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Endocrinology Division, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Petros Perros
- Department of Endocrinology, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter J Dolman
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Mario Salvi
- Department of Clinical and Community Services, Graves’ Orbitopathy Center, Endocrinology, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Marius N Stan
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, Minnesota, USA
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17
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Ueland HO, Ueland GÅ, Løvås K, Breivk LE, Thrane AS, Meling Stokland AE, Rødahl E, Husebye ES. Novel inflammatory biomarkers in thyroid eye disease. Eur J Endocrinol 2022; 187:293-300. [PMID: 35675127 PMCID: PMC9723260 DOI: 10.1530/eje-22-0247] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/08/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE The aim of this study is to identify biochemical inflammatory markers predicting the presence or risk of developing thyroid eye disease (TED) in patients with Graves' disease (GD). METHODS Patients with GD (n = 100, 77 females) were included from the National Norwegian Registry of Organ-Specific Diseases. Serum samples were analysed for 92 different inflammatory biomarkers using the proximity extension assay. Biomarker levels were compared between groups of patients with and without TED and healthy subjects (HS) (n = 120). RESULTS TED was found in 36 of 100 GD patients. Significant (P < 0.05) differences in the levels of 52 inflammatory biomarkers were found when GD patients and HS were compared (42 elevated and 10 decreased). Out of the 42 elevated biomarkers, a significantly higher serum level of interleukin-6 (IL6) (P = 0.022) and macrophage colony-stimulating factor (CSF1) (P = 0.015) were found in patients with TED compared to patients without TED. Patients with severe TED also had significantly elevated levels of Fms-related tyrosine kinase 3 ligand (FLT3LG) (P = 0.009). Furthermore, fibroblast growth factor 21 (FGF21) was significantly increased (P = 0.008) in patients with GD who had no signs of TED at baseline but developed TED later. CONCLUSION We demonstrate an immunologic fingerprint of GD, as serum levels of several inflammation-related proteins were elevated, while others were decreased. Distinctly increased levels of IL6, CSF1, FLT3LG, and FGF21 were observed in TED, suggesting that these inflammatory proteins could be important in the pathogenesis, and therefore potential new biomarkers for clinical use.
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Affiliation(s)
- Hans Olav Ueland
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
- Correspondence should be addressed to H O Ueland;
| | - Grethe Åstrøm Ueland
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Correspondence should be addressed to H O Ueland;
| | - Kristian Løvås
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Lars Ertesvåg Breivk
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science and K.G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
| | | | | | - Eyvind Rødahl
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Eystein Sverre Husebye
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science and K.G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
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18
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Tran AQ, Zhou HW, Nanda T, Godfrey KJ, Tooley AA, North VS, Kazim M. Evolution of asymmetric proptosis during the active phase of thyroid eye disease. Orbit 2022; 42:251-255. [PMID: 35801656 DOI: 10.1080/01676830.2022.2088807] [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: 10/17/2022]
Abstract
PURPOSE To assess the evolution of proptosis asymmetry during the active phase of bilateral thyroid eye disease (TED). METHODS A retrospective study was conducted on patients with bilateral, active TED. Patients were measured by a single observer, using Hertel exophthalmometry from the time of initial presentation, during the active phase of TED, to the stable phase, 24-months later. Asymmetric proptosis was defined as a >2 mm intra-orbital difference in Hertel measurements. RESULTS Fifty-one patients were enrolled. Patients presented at a mean time of 1.1 ± 2.9 months following the onset of TED symptoms. Stability of TED was established at 15.7 ± 12.3 months. At initial presentation, 41% of patients demonstrated asymmetric proptosis. Upon reaching the stable phase, asymmetric proptosis persisted in only 22% of patients. A decline in the rate asymmetric proptosis was greatest within the first 3 months of the active phase. CONCLUSIONS Asymmetric proptosis is common in the setting of early active TED and decreases by 50% when the stable phase is reached. Therefore, diagnostic imaging is not routinely required to exclude alternative pathology in the cases of asymmetric TED. Perhaps more importantly, this finding supports the surgical paradigm of stable phase, graded orbital decompression, performed when the ultimate globe positions are achieved to avoid late postoperative asymmetry, resulting from the unanticipated evolution of proptosis when surgery is performed during the active phase of TED.
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Affiliation(s)
- Ann Q Tran
- Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian HospitalOculoplastic and Orbital Surgery, Edward S. , New York, New York, USA.,Department of Ophthalmology, University of Illinois Eye and Ear Infirmary, Chicago, Illinois, USA
| | - Henry W Zhou
- Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian HospitalOculoplastic and Orbital Surgery, Edward S. , New York, New York, USA
| | - Tavish Nanda
- Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian HospitalOculoplastic and Orbital Surgery, Edward S. , New York, New York, USA
| | - Kyle J Godfrey
- Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian HospitalOculoplastic and Orbital Surgery, Edward S. , New York, New York, USA.,Department of Ophthalmology and Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Andrea A Tooley
- Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian HospitalOculoplastic and Orbital Surgery, Edward S. , New York, New York, USA.,Department of Ophthalmology, Mayo University, Rochester, Minnesota, USA
| | - Victoria S North
- Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian HospitalOculoplastic and Orbital Surgery, Edward S. , New York, New York, USA
| | - Michael Kazim
- Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian HospitalOculoplastic and Orbital Surgery, Edward S. , New York, New York, USA
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19
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Latif N, Naroo SA. Transient effects of smoking on the eye. Cont Lens Anterior Eye 2022; 45:101595. [DOI: 10.1016/j.clae.2022.101595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 02/17/2022] [Accepted: 04/03/2022] [Indexed: 11/29/2022]
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20
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Levy N, Leiba H, Landau K, Zloto O, Huna-Baron R. Clinical profile of 80-year-old and older thyroid eye disease patients. Graefes Arch Clin Exp Ophthalmol 2022; 260:2727-2736. [PMID: 35338398 DOI: 10.1007/s00417-022-05627-4] [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: 10/05/2021] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Thyroid eye disease (TED), an autoimmune orbital disorder, follows a time-of-onset bimodal peak: 40-44 and 60-64 years for women, 45-49 and 65-69 years for men. TED, however, can also commence in old age. The study's purpose was to evaluate TED in octo- and nonagenarians. METHODS Medical records of 19 ≥ 80 years geriatric patients at time of diagnosis were compared to 122 TED patients, aged 20-79. A second analysis was performed after subdividing the control group into two age groups, ≤ 40 ("young group," 16 patients) and 41-79 years ("middle-aged group," 106 patients). RESULTS The geriatric group's mean age was 84 years (80-94), 11 males and 8 females. Mean follow-up time was 16 months. Compared to the controls, the geriatric patients smoked less (p = 0.012), were more often hypothyroid (p = 0.019), and had concurrent myasthenia gravis (p = 0.02) at time of diagnosis. Diplopia was the most common presenting symptom among the elderly (p = 0.005) and proptosis among the controls, specifically the young group (p = 0.027). Bilateral signs were more common among seniors (p = 0.049). Optic neuropathy was diagnosed in 10% of the geriatric group (2/19) and 11% of middle-aged group (12/106), all being resolved after steroids or orbital decompression. Active disease (clinical activity score (CAS) score = > 3) was more common among the middle-aged group (p = 0.024) while the geriatric patients tended towards higher TED severity grades. Orbital decompression and eyelid repositioning surgeries were more common among the middle-aged group. Strabismus surgeries were more common among seniors. CONCLUSIONS TED among octo- and nonagenarians has unique patterns, with different demographic features, more exposed to diplopia, hypothyroidism, association with myasthenia gravis, and bilateral involvement. Special attention should be given when medically managing this subgroup.
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Affiliation(s)
- Niv Levy
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel.,The Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Hana Leiba
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel.,The Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Klara Landau
- Department of Ophthalmology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Ofira Zloto
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruth Huna-Baron
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Bustamante-Arias A, Ruiz Lozano RE, Rodriguez-Garcia A. Dry eye disease, a prominent manifestation of systemic autoimmune disorders. Eur J Ophthalmol 2022; 32:3142-3162. [PMID: 35300528 DOI: 10.1177/11206721221088259] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Dry eye disease (DED) is arguably the most frequent ocular disease encountered in ophthalmic clinical practice. DED is frequently an underestimated condition causing a significant impact on visual function and quality of life. Many systemic autoimmune diseases (SAIDs) are related to moderate to severe DED. The main objective of this review is to enhance the awareness among ophthalmologists of the potential association of an underlying SAID in a high-risk patient with DED. METHODS An exhaustive literature search was performed in the National Library of Medicine's Pubmed, Scopus, Web of Science, and Google Scholar databases for all English language articles published until November 2021. The main keywords included "dry eye disease" associated with autoimmune, connective tissue, endocrine, gastrointestinal, hematopoietic, vascular, and pulmonary diseases. Case reports, series, letters to the editor, reviews, and original articles were included. RESULTS Although DED is frequently associated with SAIDs, its diagnosis is commonly delayed or missed, producing significant complications, including corneal ulceration, melting, scleritis, uveitis, and optic neuritis resulting in severe complications detrimental to visual function and quality of life. SAID should be suspected in a woman, 30 to 60 years old with a family history of autoimmunity, presenting with DED symptoms and extraocular manifestations including arthralgias, dry mouth, unexplained weight and hair loss, chronic fatigue, heat or cold intolerance, insomnia, and mood disorders. CONCLUSIONS Establishing the correct diagnosis and treatment of DED associated with SAIDs is crucial to avoid its significant burden and severe ocular complications.
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Affiliation(s)
- Andres Bustamante-Arias
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Raul E Ruiz Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
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22
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Nabi T, Rafiq N. Comment on “factors associated with severity of orbitopathy in patients with Graves' disease. Taiwan J Ophthalmol 2022; 12:118-119. [PMID: 35399973 PMCID: PMC8988982 DOI: 10.4103/tjo.tjo_3_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 12/02/2022] Open
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Eshraghi B, Nikdel M, Abbasi M. Epidemiological Status of Thyroid Eye Disease in Central Iran. J Curr Ophthalmol 2022; 34:106-111. [PMID: 35620368 PMCID: PMC9128421 DOI: 10.4103/joco.joco_223_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose To focus on clinical manifestations and epidemiology of thyroid eye disease (TED) in Central Iran's population. Methods In this retrospective case study, we analyzed all patients with TED who were referred to our oculoplastic clinic from 2015 to 2019. The patients' epidemiological characteristics and clinical presentation were compared between different thyroid disease groups and genders. Results Overall, 383 patients (155 male; 40.5% and 228 female; 59.5%) were included. The mean age was 39.55 years (standard deviation ± 13.45, range 10-72). Most patients (89%) were hyperthyroid with the highest duration of ocular involvement among all categories (25.6 months). The most common signs on ophthalmic examinations were proptosis (80.4%), followed by eyelid retraction (72.3.0%). TED was classified as mild in 24.5%, moderate to severe in 67.6%, and sight-threatening in 7.9%. Thirty patients (7.8%) had active TED. Conclusions This series with a relatively more significant number of TED cases in Central Iran found similar epidemiological and clinical characteristics of TED compared to other studies from Iran. Most of our patients were hyperthyroid, with more females compared to males. Proptosis and eyelid retraction were the most common manifestations. Most TED patients were classified as moderate to severe.
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Affiliation(s)
- Bahram Eshraghi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Maryam Abbasi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
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Razeghinejad MR, Farsiani AR, Salout R, Owji N, Masoumpour M, Kharmandar A, Zamani M. Corneal biomechanical properties in hyperthyroidism and thyroid eye disease. Saudi J Ophthalmol 2021; 34:251-255. [PMID: 34527867 PMCID: PMC8409357 DOI: 10.4103/1319-4534.322605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/21/2020] [Accepted: 07/06/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE: The purpose of this study is to compare the corneal biomechanical properties of hyperthyroids without ophthalmopathy (HWO), thyroid eye disease (TED), and euthyroid participants. METHODS: In this prospective comparative study, one eye per patient included in the analysis and according to exclusion criteria, 38 eyes of 40 HWO patients, 31 eyes of 40 TED patients, and 150 eyes of 160 age- and sex-matched euthyroid participants were enrolled. All participants were evaluated by an endocrinologist and oculoplastic surgeon for evaluation of thyroid function and orbitopathy, respectively. Measurements of corneal biomechanical properties were performed using ocular response analyzer and Corvis ST tonometers. RESULTS: In the HWO group, applanation-1 length (A1 L), applanation-2 velocity (A2V) (P < 0.001), and corneal resistant factor (P = 0.043) were higher than the control group and corneal hysteresis (CH) was lower (P = 0.018). In the TED group, A1 L, A2V (P < 0.001), and highest concavity radius (HCR) (P = 0.027) were higher than the control group, and the CH (P = 0.007) and highest concavity deformation amplitude (HCDA) (P = 0.001) were lower. Furthermore, the level HCDA in the TED group was lower than HWO group (P = 0.011). The level of upper scleral show and palpebral fissure had a negative correlation with CH and HCDA. The amount of exophthalmos level had a positive correlation with HCR. CONCLUSION: Corneal biomechanical properties in the HWO and TED groups were different from the normal euthyroid individuals and may be taken into account in managing situation like glaucoma and refractive surgeries.
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Affiliation(s)
- M Reza Razeghinejad
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Amir R Farsiani
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Ophthalmology, School of Medicine, Zanjan University of Medical sciences, Zanjan, Iran
| | - Ramin Salout
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Salouti Eye Research Center, Salouti Eye Clinic, Shiraz, Iran
| | - Naser Owji
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoumeh Masoumpour
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Kharmandar
- Endocrine and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Zamani
- Salouti Eye Research Center, Salouti Eye Clinic, Shiraz, Iran
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Ong AA, DeVictor S, Vincent AG, Namin AW, Wang W, Ducic Y. Bony Orbital Surgery for Graves' Ophthalmopathy. Facial Plast Surg 2021; 37:692-697. [PMID: 34500489 DOI: 10.1055/s-0041-1735638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The majority of Graves' ophthalmopathy, or thyroid eye disease, can be managed medically; however, in refractory or severe cases, surgical intervention with orbital decompression may be necessary. The majority of the published literature is retrospective in nature, and there is no standardized approach to orbital decompression. The purpose of this review is to evaluate the various surgical approaches and techniques for orbital decompression. Outcomes are ultimately dependent on individual patient factors, surgical approach, and surgeon experience.
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Affiliation(s)
- Adrian A Ong
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Samuel DeVictor
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York
| | - Aurora G Vincent
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Arya W Namin
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Weitao Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Rochester, Rochester, New York
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Khamisi S, Lundqvist M, Emadi P, Almby K, Ljunggren Ö, Karlsson FA. Serum thyroglobulin is associated with orbitopathy in Graves' disease. J Endocrinol Invest 2021; 44:1905-1911. [PMID: 33515213 PMCID: PMC8357771 DOI: 10.1007/s40618-021-01505-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/08/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Serum thyroglobulin levels are often elevated in Graves' disease (GD) and in most cases decrease during treatment. Its relation to Graves' orbitopathy (GO) has not been clarified. Previously, a risk of GO has been linked to smoking, TSH receptor stimulation, high TSH-receptor antibodies (TRAb), low thyroid peroxidase and thyroglobulin antibodies (TPOAb, TgAb). METHODS We examined Tg levels in 30 consecutive patients with GD were given drug therapy (methimazole + thyroxine) for up to 24 months. GO was identified by clinical signs and symptoms. 17 patients had GO, 11 of whom had it at diagnosis while 6 developed GO during treatment. During the study, 5 subjects were referred to radioiodine treatment, 3 to surgery. The remaining 22 subjects (GO n = 12, non-GO n = 10) completed the drug regimen. RESULTS At diagnosis, Tg levels in GO patients (n = 11) were higher (84, 30-555 µg/L, median, range) than in non-GO patients (n = 19) (38, 3.5-287 µg/L), p = 0.042. Adding the 6 subjects who developed eye symptoms during treatment to the GO group (n = 17), yielded p = 0.001 vs. non-GO (n = 13). TRAb tended to be higher, while TPOAb and TgAb tended to be lower in the GO group. For the 22 patients who completed the drug regimen, Tg levels were higher in GO (n = 12) vs. non-GO (n = 10), p = 0.004, whereas TRAb levels did not differ. CONCLUSION The data may suggest that evaluation of thyroglobulin levels in GD could contribute to identify patients at increased risk of developing GO. Possibly, thyroidal release of Tg in GD reflects a disturbance that also impacts retroorbital tissues.
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Affiliation(s)
- S Khamisi
- Department of Endocrinology and Diabetes, Uppsala University Hospital, 751 85, Uppsala, Sweden.
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - M Lundqvist
- Department of Endocrinology and Diabetes, Uppsala University Hospital, 751 85, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - P Emadi
- Department of Ophthalmology, Uppsala University Hospital, Uppsala, Sweden
| | - K Almby
- Department of Endocrinology and Diabetes, Uppsala University Hospital, 751 85, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ö Ljunggren
- Department of Endocrinology and Diabetes, Uppsala University Hospital, 751 85, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - F A Karlsson
- Department of Endocrinology and Diabetes, Uppsala University Hospital, 751 85, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Sight-Threatening Thyroid Eye Disease: Role of Diabetes Mellitus and Interaction with Other Risk Factors. Ophthalmic Plast Reconstr Surg 2021; 37:352-360. [PMID: 33060509 DOI: 10.1097/iop.0000000000001871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the study was to investigate whether diabetes mellitus (DM) is an independent risk factor in sight-threatening thyroid eye disease (ST-TED) and explore the interaction of DM with other known risk factors in TED. METHODS This was a retrospective cohort study and included 202 consecutive TED patients presenting between 2013 and 2019. Data collected included demography, history of smoking, thyroid dysmetabolism, and presence of DM, TED-duration, activity and severity, best-corrected visual acuity (BCVA), and follow-up. Primary outcome measure was development of ST-TED and secondary outcome measures included change in BCVA, activity, and bilateral ST-TED. RESULTS Mean age of the cohort was 52.14 + 9.14 years and 74 (36%) were male. DM was present in 49 (24%) and a positive history of smoking in 65 (32%) TED patients. Cox's proportional hazards showed the presence of DM (hazard ratio [HR] 2.22; P = 0.02) and a positive history of smoking (HR 3.62; P = 0.003) were significant risk factors for development of ST-TED and dysthyroid optic neuropathy (DON). Older age was a risk factor (HR 1.05; P = 0.02) for DON. DM increased the risk of developing bilateral ST-TED (OR 4.14; P = 0.004). Median follow-up was 4 months (range 0.1-96 months). A linear mixed model to predict longitudinal interaction between risk factors, found TED patients in DM group were likely to have worsening of visual function and a positive history of smoking accentuated this adverse outcome. CONCLUSION DM and smoking are major independent risk factors predictive of ST-TED. Coexisting DM either singularly or in combination with smoking may predict worsening of visual function in TED patients.
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Choi JH, Noh H, Kim YD, Woo KI. Prognostic factors of restrictive myopathy in thyroid eye disease. Sci Rep 2021; 11:13781. [PMID: 34215786 PMCID: PMC8253730 DOI: 10.1038/s41598-021-93275-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/23/2021] [Indexed: 11/09/2022] Open
Abstract
To investigate the prognostic factors of extraocular muscle restriction in patients with thyroid eye disease (TED), 65 patients with TED and restrictive myopathy were evaluated. Demographics, clinical activity score (CAS), smoking status, thyroid disease status, thyroid hormone status, thyroid autoantibody status, orbital computed tomography (CT) scan at initial presentation, and treatment regimens were assessed. The movements of the most severely affected extraocular muscles were categorized into five grades. The patients were divided into the improved and the not-improved group based on the improvement in the limitation of the extraocular muscle excursion (LOM) throughout the follow-up, and the groups were compared using clinical factors. The mean LOM significantly improved from 2.3 ± 1.1 to 1.7 ± 1.2 after 1 year of follow-up. The excursion of the most restricted muscle improved in 32 patients but not in 33 patients during the follow-up. The initial concentration of the thyroid-stimulating antibody (TSAb) was significantly lower in the improved (229.3 ± 114.1) than in the not-improved group (345.0 ± 178.6) (P = 0.02) Age, sex, smoking status, CAS, thyroid status, and muscle thickness on the CT scan did not significantly differ in the groups. This study showed that the initial concentration of TSAb is a factor affecting the recovery of restrictive myopathy.
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Affiliation(s)
- Jae Hwan Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Hoon Noh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | | | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
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Abstract
PURPOSE OF REVIEW This review aims to bring together recent advances in basic, translational and clinical research on the pathogenesis and treatment of orbital inflammatory conditions. RECENT FINDINGS Basic science studies provide mechanistic insights into why the orbit is targeted for inflammation by autoimmune inflammatory disorders. Using Graves' disease as a test case reveals that endocrine pathways, such as the TSH and IGF1 receptor pathways play important roles in stimulating orbital inflammation. Furthermore, orbital tissues contain high concentrations of retinoids - byproducts of the visual pathway that diffuse across the sclera and can activate de novo transcription of inflammatory cytokines. Such cytokine expression places the orbit in a hyper-inflammatory 'resting' state, prone to respond to any additional systemic or local pro-inflammatory signals. The HIF2A--LOX pathway appears important for orbital tissue fibrosis. Lastly, bench-to-bedside studies of the IGF1R pathway have led to an FDA-approved drug, teprotumumab that represents a novel treatment approach for Graves' orbitopathy. Unfortunately, high drug costs and misplaced insurance company 'step-therapy' policies may block patients from receiving therapy that can protect vision and improve quality of life. SUMMARY Improved understanding of orbital inflammatory conditions has led to a new drug and promises additional breakthroughs. Translational research is successful, but requires time, resources, and patience.
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Loiudice P, Pellegrini M, Marinò M, Mazzi B, Ionni I, Covello G, Figus M, Nardi M, Casini G. Choroidal vascularity index in thyroid-associated ophthalmopathy: a cross-sectional study. EYE AND VISION 2021; 8:18. [PMID: 33926559 PMCID: PMC8086083 DOI: 10.1186/s40662-021-00242-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 04/13/2021] [Indexed: 11/22/2022]
Abstract
Background Hemodynamic changes have been observed in patients with Graves’ disease. The aim of our study was to evaluate choroidal vascular change using the choroidal vascularity index (CVI) in patients with thyroid-associated ophthalmopathy (TAO). Methods In this cross-sectional observational study, 40 patients affected by TAO were recruited. Forty healthy individuals, matched for age and sex, served as controls. Foveal enhanced-depth imaging optical coherence tomography scans were obtained from all participants. Images were binarized using the ImageJ software and luminal area (LA) and total choroidal area (TCA) were measured. CVI was calculated as the proportion of LA to TCA. The relation between CVI or subfoveal choroidal thickness (SFCT) and clinical activity score, exophthalmometric value, diplopia status, gender, and age was evaluated. Results CVI was significantly higher in patients with TAO (P = 0.004). No significant difference was observed in SFCT (P = 0.200) and TCA (P = 0.153) comparing TAO patients and healthy controls. LA was significantly higher in TAO group (P = 0.045). On multiple regression analysis, CVI was associated with TCA (P = 0.043). No association was found between SFCT or CVI and TCA, clinical activity score, exophthalmometric value, Inami value, diplopia status, gender or age (P > 0.05). Conclusions This is the first study that has demonstrated an increase in CVI in eyes with TAO compared with healthy controls and has assessed its association with clinical features.
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Affiliation(s)
- Pasquale Loiudice
- Department of Surgical, Ophthalmology Unit, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Savi, 10, 56126, Pisa, Italy.
| | - Marco Pellegrini
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Michele Marinò
- Department of Clinical and Experimental Medicine, Endocrinology Unit I, University Hospital of Pisa, Pisa, Italy
| | - Barbara Mazzi
- Department of Clinical and Experimental Medicine, Endocrinology Unit I, University Hospital of Pisa, Pisa, Italy
| | - Ilaria Ionni
- Department of Clinical and Experimental Medicine, Endocrinology Unit I, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe Covello
- Department of Surgical, Ophthalmology Unit, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | - Michele Figus
- Department of Surgical, Ophthalmology Unit, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | - Marco Nardi
- Department of Surgical, Ophthalmology Unit, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | - Giamberto Casini
- Department of Surgical, Ophthalmology Unit, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
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Sheck LH, Field AP, Mcrobbie H, Wilson GA. Helping patients to quit smoking in the busy optometric practice. Clin Exp Optom 2021; 92:75-7. [DOI: 10.1111/j.1444-0938.2009.00348.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Leo Hn Sheck
- Department of Ophthalmology, Gisborne Hospital, New Zealand
| | | | - Hayden Mcrobbie
- Department of Public Health and Psychosocial Studies, Auckland University of Technology
E‐mail:
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Zou H, Xu W, Wang Y, Wang Z. A data-driven approach for the discovery of biomarkers associated with thyroid eye disease. BMC Ophthalmol 2021; 21:166. [PMID: 33832456 PMCID: PMC8034124 DOI: 10.1186/s12886-021-01903-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background Thyroid eye disease (TED) is the most common autoimmune disease and usually occurs in patients with hyperthyroidism. In this disease, eye-related tissue, such as eye muscles, eyelids, tear glands, etc., become inflated, which causes the eyes and eyelids to become red, swollen, and uncomfortable. The pathophysiology of this disease is still poorly known. Aim This study aims to discover potential biomarkers and regulatory pathways of TED which will not only help to diagnose the disease and understand orbital involvement in thyroid dysfunction but also provide an insight for better therapeutics. Methods We applied a data-driven approach by combining gene biomarkers both from published literature and computationally predicted from microarray gene expression data. Further, the DAVID tool is used for Gene Ontology-based enrichment analysis. Results We obtained a total of 22 gene biomarkers, including 18 semi-automatically curated from the literature and 4 predicted using data-driven approaches, involved in the pathogenesis of TED that can be used as potential information for therapeutic targets. Further, we constructed a regulatory pathway of TED biomarkers comprises of 310 connected components, and 1134 interactions using four prominent interaction databases. Conclusion This constructed pathway can be further utilized for disease dynamics and simulation studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01903-9.
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Affiliation(s)
- Huihui Zou
- Department of Ophthalmology, Dezhou People's Hospital, Dezhou, 253000, China
| | - Weiwei Xu
- Department of Ophthalmology, Dezhou People's Hospital, Dezhou, 253000, China
| | - Ying Wang
- Department of Ophthalmology, Dezhou Women's and Children's Hospital, Shandong, China
| | - Zhihong Wang
- Department of Ophthalmology, Dezhou People's Hospital, Dezhou, 253000, China.
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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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Exposure to Secondhand Smoke in Children is Associated with a Thinner Retinal Nerve Fiber Layer: The Hong Kong Children Eye Study. Am J Ophthalmol 2021; 223:91-99. [PMID: 33129810 DOI: 10.1016/j.ajo.2020.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE We sought to assess the effects of exposure to secondhand smoke (SHS) on peripapillary retinal nerve fiber layer (p-RNFL) thickness in children. DESIGN Cross-sectional study. METHODS Children 6-8 years of age were consecutively recruited from the population-based Hong Kong Children Eye Study. All participants received comprehensive ophthalmic examinations and p-RNFL thickness was measured by spectral-domain optical coherence tomography. SHS data were derived from a validated questionnaire. Associations between p-RNFL thickness and SHS exposure status, number of smokers in the family, and quantity of smoking in the family were determined by multivariate linear regression after adjusting for potential confounders. RESULTS Among the Hong Kong Children Eye Study cohort (n = 3,103), approximately one-third of children were exposed to SHS (35.4%, n = 1,097). Compared to those without exposure to SHS, children exposed to SHS had similar age (P = .83), gender (P = .17), body mass index (P = .44), birth weight (P = .23), and axial length (P = .34), but had lower family income (P < .001) and lower parental education level (P < .001). After adjusting for all the above factors, exposure to SHS was associated with a thinner global p-RNFL by 4.4 μm (P < .001). Reduced p-RNFL was also associated with increased numbers of smokers in the family (β = -3.40, P < .001) and increased quantity of SHS (β = -0.22, P < .001). CONCLUSIONS Exposure to SHS in children was associated with a thinner p-RNFL. A thinner p-RNFL may increase the risk of irreversible visual impairment in the future. Our results provide evidence to recommend that children avoid exposure to SHS.
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Mbarek S, Abid F, Ammari W, Alaya W, Mahmoud A, Messaoud R. Graves' Orbitopathy: Report of 82 cases. LA TUNISIE MEDICALE 2021; 99:243-251. [PMID: 33899194 PMCID: PMC8724701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Graves' disease (GD) is a common autoimmune disorder. Graves'orbitopathy (GO) is its most common extrathyroidal manifestation. It is rare but may reveal the disease. AIM To describe the demographic, clinical and therapeutic features of GO. METHODS We carried out a retrospective and descriptive analysis of 82 patients with GO. This study was conducted in Ophthalmology and Endocrinology departments of Taher Sfar University Hospital in Mahdia, between January 2010 and December 2017. GD patients diagnosed with GO were included. RESULTS The mean age was 36.17 years ± 12.81. Patients aged 19-40 years had the highest rate of GO. The male-to-female ratio was 0.49. Family history of autoimmune thyroid disease was present in 15% and associated autoimmune disease in 4% of cases. Smoking was seen in 71% of patients. The onset of GO was simultaneous with onset of GD in 45%, before in 21% and after the onset of GD in 34% of cases. GO was bilateral in 76% of patients. The most common ocular symptoms were prominent eyes (55% of patients), ocular pain (11%) and diplopia (41%). Proptosis and upper eyelid retraction were the most common clinical signs (93% and 90% respectively). Dysthyroid optic neuropathy was present in one eye, keratitis in one eye and glaucoma in five eyes. Severe disease was noted in 11% and active disease was present in 7% of patients. CT-scan and magnetic resonance imaging scan (MRI) were performed in 48% and 42% of cases respectively. Proptosis was the most common radiological sign. Thyroid dysfunction was managed with anti-thyroid medication only (59%), thyroxine replacement (37%), radioactive iodine (35%) and thyroidectomy (6%). 20% of patients received corticosteroids. One patient required immunosuppressive therapy. CONCLUSION GO is a complex disease, which is associated with impaired quality of life and can potentially result in sight-threatening complications. Appropriate diagnosis, convenient therapy and a regular follow-up are necessary to improve results and avoid the aesthetic and functional sequelae.
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Affiliation(s)
- Sameh Mbarek
- 1-Service d'ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia, Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Fatma Abid
- 1-Service d'ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia, Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Wafa Ammari
- 1-Service d'ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia, Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Wafa Alaya
- 2-Service d'endocrinologie, Centre hospitalo-universitaire Taher Sfar, Mahdia, Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Anis Mahmoud
- 1-Service d'ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia, Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Riadh Messaoud
- 1-Service d'ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia, Université de Monastir, Tunisie / faculté de médecine de Monastir
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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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Hammond CL, Roztocil E, Gonzalez MO, Feldon SE, Woeller CF. MicroRNA-130a Is Elevated in Thyroid Eye Disease and Increases Lipid Accumulation in Fibroblasts Through the Suppression of AMPK. Invest Ophthalmol Vis Sci 2021; 62:29. [PMID: 33507228 PMCID: PMC7846950 DOI: 10.1167/iovs.62.1.29] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose Thyroid eye disease (TED) is a condition that causes the tissue behind the eye to become inflamed and can result in excessive fatty tissue accumulation in the orbit. Two subpopulations of fibroblasts reside in the orbit: those that highly express Thy1 (Thy1+) and those with little or no Thy1 (Thy1–). Thy1– orbital fibroblasts (OFs) are more prone to lipid accumulation than Thy1+ OFs. The purpose of this study was to investigate the mechanisms whereby Thy1– OFs more readily accumulate lipid. Methods We screened Thy1+ and Thy1– OFs for differences in microRNA (miRNA) expression. The effects of increasing miR-130a levels in OFs was investigated by measuring lipid accumulation and visualizing lipid deposits. To determine if adenosine monophosphate-activated protein kinase (AMPK) is important for lipid accumulation, we performed small interfering RNA (siRNA)-mediated knockdown of AMPKβ1. We measured AMPK expression and activity using immunoblotting for AMPK and AMPK target proteins. Results We determined that miR-130a was upregulated in Thy1– OFs and that miR-130a targets two subunits of AMPK. Increasing miR-130a levels enhanced lipid accumulation and reduced expression of AMPKα and AMPKβ in OFs. Depletion of AMPK also increased lipid accumulation. Activation of AMPK using AICAR attenuated lipid accumulation and increased phosphorylation of acetyl-CoA carboxylase (ACC) in OFs. Conclusions These data suggest that when Thy1– OFs accumulate in TED, miR-130a levels increase, leading to a decrease in AMPK activity. Decreased AMPK activity promotes lipid accumulation in TED OFs, leading to excessive fatty tissue accumulation in the orbit.
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Affiliation(s)
- Christine L Hammond
- Flaum Eye Institute, University of Rochester, Rochester, New York, United States
| | - Elisa Roztocil
- Flaum Eye Institute, University of Rochester, Rochester, New York, United States
| | - Mithra O Gonzalez
- Flaum Eye Institute, University of Rochester, Rochester, New York, United States
| | - Steven E Feldon
- Flaum Eye Institute, University of Rochester, Rochester, New York, United States
| | - Collynn F Woeller
- Flaum Eye Institute, University of Rochester, Rochester, New York, United States
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Nabi T, Rafiq N, Dar I. Risk factors for thyroid-associated orbitopathy due to Graves' disease. JOURNAL OF CLINICAL OPHTHALMOLOGY AND RESEARCH 2021. [DOI: 10.4103/jcor.jcor_67_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ahmad SS, Anwar R, Khan MA, Usmani N, Jahan S. Evaluation of Proptosis: A Primer. Ophthalmology 2021. [DOI: 10.17925/opht.2021.15.1.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Tabriz N, Gruben A, Uslar V, Weyhe D. Risk factors for Graves' Orbitopathy in surgical patients-Results of a 10-year retrospective study with review of the literature. Endocrinol Diabetes Metab 2021; 4:e00210. [PMID: 33532627 PMCID: PMC7831207 DOI: 10.1002/edm2.210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/24/2020] [Accepted: 10/18/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction We investigated known (eg age, smoking, thyrotropin receptor autoantibody (TRAb)) and new risk factors (eg thyroid peroxidase autoantibodies (TPO-Ab), thyroid size, or BMI) for Graves' disease (GD) and Graves' orbitopathy (GO), especially in combination with each other, to determine which factors play the most important role in the development of GO. Methods From 2008 to 2018, n = 500 patients with GD were included in this retrospective single-centre case-control study. N = 231 (46%) had a GO and n = 269 (54%) showed no GO. Differences in risk factors were determined by Mann-Whitney U and chi-square test. Combined influences of factors were examined by multivariable logistic regression. Results Age at first diagnosis of GD (OR = 1.043, p < .006), smoking status (OR = 2.64, p < .026) and TRAb (OR = 1.046, p < .01) had a significant impact on GO. The factors gender, TPO-Ab titre, BMI, TSH titre, T3 and T4 were not significant. Conclusion As it has been shown in univariate analyses, smoking, age and TRAb levels have a negative impact on the onset and course of GD and GO. Via multivariable regression, we could additionally show that smoking is the most important factor out of those analysed. TRAb might be a helpful surrogate parameter in the assessment of the progress of GO and therefore might be one factor in the decision-making process for potential early operative surgery. With regard to the hitherto unclear role of BMI, thyroid size and TPO-Ab in the course of GO, this study could not find any clinically relevant influence.
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Affiliation(s)
- Navid Tabriz
- School of Medicine and Health SciencesUniversity Hospital for Visceral SurgeryPius‐Hospital OldenburgCarl von Ossietzky University OldenburgOldenburgGermany
| | - Arved Gruben
- School of Medicine and Health SciencesUniversity Hospital for Visceral SurgeryPius‐Hospital OldenburgCarl von Ossietzky University OldenburgOldenburgGermany
| | - Verena Uslar
- School of Medicine and Health SciencesUniversity Hospital for Visceral SurgeryPius‐Hospital OldenburgCarl von Ossietzky University OldenburgOldenburgGermany
| | - Dirk Weyhe
- School of Medicine and Health SciencesUniversity Hospital for Visceral SurgeryPius‐Hospital OldenburgCarl von Ossietzky University OldenburgOldenburgGermany
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Rath S. Commentary: Risk factors predicting visual morbidity in thyroid eye disease. Indian J Ophthalmol 2020; 68:1627-1628. [PMID: 32709793 PMCID: PMC7640872 DOI: 10.4103/ijo.ijo_1851_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Suryasnata Rath
- Ophthalmic Plastic and Reconstructive Surgery Services, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
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Nabi T, Rafiq N. Factors associated with severity of orbitopathy in patients with Graves' disease. Taiwan J Ophthalmol 2020; 10:197-202. [PMID: 33110751 PMCID: PMC7585466 DOI: 10.4103/tjo.tjo_10_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/10/2020] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Graves' orbitopathy (GO) is one of the most frequent orbital disorders and is the most common cause of proptosis in adults. GO is described as chronic inflammation of orbital and periorbital tissues. This study aimed to evaluate the risk factors for severe GO in patients with Graves' disease (GD). MATERIALS AND METHODS This was a prospective cross-sectional study done on 52 newly diagnosed patients of GD with GO documented by thyroid 99mTechnetium-pertechnetate scan at our center between May 2016 and May 2019. All patients underwent a comprehensive ophthalmological examination and laboratory and hormonal analysis. Clinical Activity Score (CAS) and severity were estimated as per the European Group on Graves Orbitopathy. Thirty-four patients with mild GO were compared with 18 patients with moderate-to-severe GO (severe) for baseline risk parameters. RESULTS Majority of the patients had mild orbitopathy (34 [65.4%]) followed by moderate to severe (18 [34.6%]). CAS was active in 13.5% of the study group. There was a statistically significant male preponderance in severe GO. Current smoking increased the risk of severe GO (P = 0.003). Duration of GD symptoms at presentation was statistically significantly longer in severe GO patients than mild GO (P = 0.004). Thyrotropin receptor antibody (TRAb) titer significantly increased in severe GO group (6.2 ± 2.4 IU/L) when compared to mild GO (3.2 ± 1.6 IU/L) (P < 0.001). TRAb positivity was similar between groups. Braley's sign, i.e., the differential intraocular pressure (IOP) of >6 mmHg, was statistically significantly higher in severe GO (P < 0.001). Male gender, current smoking, TRAb >2 upper limit of normal (ULN), and differential IOP >6 mmHg were found to be associated with severe GO. CONCLUSION Approximately 35% of the patients with GO have severe disease, with a higher risk in men. This study identified male gender, current smoking, TRAb >2 ULN, and differential IOP >6 mmHg to be associated with severe GO.
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Affiliation(s)
- Tauseef Nabi
- Department of Endocrinology, MMSSH, Ambala, Haryana, India
| | - Nadeema Rafiq
- Department of Physiology, Government Medical College, Baramulla, Jammu and Kashmir, India
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Roztocil E, Hammond CL, Gonzalez MO, Feldon SE, Woeller CF. The aryl hydrocarbon receptor pathway controls matrix metalloproteinase-1 and collagen levels in human orbital fibroblasts. Sci Rep 2020; 10:8477. [PMID: 32439897 PMCID: PMC7242326 DOI: 10.1038/s41598-020-65414-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/04/2020] [Indexed: 12/13/2022] Open
Abstract
Thyroid eye disease (TED) affects 25–50% of patients with Graves’ Disease. In TED, collagen accumulation leads to an expansion of the extracellular matrix (ECM) which causes destructive tissue remodeling. The purpose of this study was to investigate the therapeutic potential of activating the aryl hydrocarbon receptor (AHR) to limit ECM accumulation in vitro. The ability of AHR to control expression of matrix metalloproteinase-1 (MMP1) was analyzed. MMP1 degrades collagen to prevent excessive ECM. Human orbital fibroblasts (OFs) were treated with the pro-scarring cytokine, transforming growth factor beta (TGFβ) to induce collagen production. The AHR ligand, 6-formylindolo[3,2b]carbazole (FICZ) was used to activate the AHR pathway in OFs. MMP1 protein and mRNA levels were analyzed by immunosorbent assay, Western blotting and quantitative PCR. MMP1 activity was detected using collagen zymography. AHR and its transcriptional binding partner, ARNT were depleted using siRNA to determine their role in activating expression of MMP1. FICZ induced MMP1 mRNA, protein expression and activity. MMP1 expression led to a reduction in collagen 1A1 levels. Furthermore, FICZ-induced MMP1 expression required both AHR and ARNT, demonstrating that the AHR-ARNT transcriptional complex is necessary for expression of MMP1 in OFs. These data show that activation of the AHR by FICZ increases MMP1 expression while leading to a decrease in collagen levels. Taken together, these studies suggest that AHR activation could be a promising target to block excessive collagen accumulation and destructive tissue remodeling that occurs in fibrotic diseases such as TED.
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Affiliation(s)
- Elisa Roztocil
- Flaum Eye Institute, University of Rochester, Rochester, New York, 14642, USA
| | - Christine L Hammond
- Flaum Eye Institute, University of Rochester, Rochester, New York, 14642, USA
| | - Mithra O Gonzalez
- Flaum Eye Institute, University of Rochester, Rochester, New York, 14642, USA
| | - Steven E Feldon
- Flaum Eye Institute, University of Rochester, Rochester, New York, 14642, USA
| | - Collynn F Woeller
- Flaum Eye Institute, University of Rochester, Rochester, New York, 14642, USA. .,Department of Environmental Medicine School of Medicine and Dentistry, University of Rochester, Rochester, New York, 14642, USA.
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Affiliation(s)
- Marian Ludgate
- Thyroid Research Group, Division of Infection & Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, UK.
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Current Understanding of the Progression and Management of Thyroid Associated Orbitopathy: A Systematic Review. Ophthalmol Ther 2019; 9:21-33. [PMID: 31823232 PMCID: PMC7054489 DOI: 10.1007/s40123-019-00226-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Indexed: 12/20/2022] Open
Abstract
Thyroid associated orbitopathy (TAO) is a common diagnosis encountered by ophthalmologists and oculoplastic surgeons. TAO has a varying clinical presentation that can include upper eyelid retraction, restrictive strabismus, proptosis, exposure keratopathy, and optic neuropathy. In this review, we discuss the most recent literature on and the current understanding of the pathophysiology of TAO. We also review available and potential future treatment options for the management of TAO.
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de-Arriba-Palomero P, Sales-Sanz M, Fuentemilla E, Won-Kim HR, de-Arriba-Palomero F, Muñoz-Negrete FJ. Effectiveness of oral counselling for smoke cessation in Graves orbitopathy patients. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2019; 94:323-330. [PMID: 31036428 DOI: 10.1016/j.oftal.2019.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/27/2019] [Accepted: 03/13/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Smoking is an important risk factor for Graves orbitopathy (GO) and it is modifiable. The advice to stop smoking has been included in all the clinical practice guidelines of GO. However, the effectiveness of this practice remains unknown. The purpose of this study is to assess the change in the smoking habit in patients affected with GO after an oral counselling for smoking cessation. MATERIAL AND METHODS A retrospective cohort of GO patients was studied. The patients received a significant oral counsel during the first consultation with the ophthalmologist. 33 GO patients were explored in the ophthalmology clinic during 2013 and 2014 and the study was done throughout a telephone questionnaire in 2015. The main outcome was the number of cigarettes smoked daily before and after consultation with the endocrinologist and the ophthalmologist. Other medical and socioeconomic factors were recorded. RESULTS The mean number of cigarettes that were smoked was 13.6 (SD 9.66) and 6.3 (SD 7.73) before and after the consultation done at the ophthalmology office (T-test paired, P=0.0006). 42.42% achieved smoking cessation and 30.3% decreased their smoking habit. Patients who stopped smoking suffered usually from active and severe GO, had more stable jobs and received greater support from their relatives and friends. CONCLUSION A firm and strong oral counsel held for smoke cessation was effective in GO patients. This disease deeply affects patients' quality of life, making them more prone to change their habits.
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Affiliation(s)
- P de-Arriba-Palomero
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España.
| | - M Sales-Sanz
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España
| | - E Fuentemilla
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España
| | - H R Won-Kim
- Servicio de Oftalmología, Hospital Universitario La Princesa, Madrid, España
| | - F de-Arriba-Palomero
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España
| | - F J Muñoz-Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España; Universidad de Alcalá, Campus Universitario, Alcalá de Henares (Madrid), España
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Sowerby L, Rajakumar C, Allen L, Rotenberg B. Urgent endoscopic orbital decompression for vision deterioration in dysthyroid optic neuropathy. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:S49-S52. [DOI: 10.1016/j.anorl.2018.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/09/2018] [Accepted: 08/13/2018] [Indexed: 11/26/2022]
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