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Zhang H, Fan J, Qu J, Han Q, Zhou H, Song X. Predictive markers for anti-inflammatory treatment response in thyroid eye disease. Front Endocrinol (Lausanne) 2023; 14:1292519. [PMID: 38111706 PMCID: PMC10726127 DOI: 10.3389/fendo.2023.1292519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/15/2023] [Indexed: 12/20/2023] Open
Abstract
Anti-inflammatory treatment is the primary and vital therapeutic approach for active, moderate-to-severe thyroid eye disease (TED). Accurate pretreatment prediction of treatment response is of paramount importance for the prognosis of patients. However, relying solely on the clinical activity score asa determinant of activity has led to unsatisfactory treatment outcomes. In recent years, significant advancements have been made in identifying predictive markers for anti-inflammatory treatment response in TED, clinical markers, body fluid biomarkers and imaging biomarkers. Several clinical studies have developed prediction models based on these markers. However, there is still a lack of comprehensive elucidation or comparison between the different markers. Therefore, this review aims to provide a detailed analysis of the definition, characteristics, and application of predictive markers for anti-inflammatory treatment response in TED. Through detailed literature search, 26 articles applying anti-inflammatory treatment effect prediction with a total of 1948 TED patients were used for analysis and discussion. By gaining a better understanding of the current research on predictive markers, we can accelerate and guide the exploration of treatment prediction strategies, leading us towards an era of precise therapy for TED.
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Affiliation(s)
- Haiyang Zhang
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jingyuan Fan
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jialu Qu
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Qinghe Han
- Department of Radiology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Huifang Zhou
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xuefei Song
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Dave TV, Patodi P, Richhariya A, Dave VP. Thermal Imaging of the Ocular Surface in Thyroid Eye Disease: A Comparison between Active, Inactive and Healthy Eyes. Curr Eye Res 2021; 46:1482-1488. [PMID: 33745401 DOI: 10.1080/02713683.2021.1907418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aim: To report the temperature differences on the ocular surface using infrared thermal imaging (TI) in thyroid eye disease (TED) and healthy eyesMethods: Prospective, consecutive, comparative case series comparing TI parameters between active and inactive TED with healthy controls. The data captured included baseline demography, activity of TED and the TI parameters. Area under the receiver operating characteristic curves (AUROC) were calculated for the temperature values to determine the sensitivity and specificity in distinguishing active from inactive TED. The Youden index and the predictor cut off values were also reported.Results: The study included 11 eyes with active TED, 46 eyes with inactive TED and 40 eyes healthy patients. Temperatures of pre-determined points on the ocular surface in degrees were compared between the three groups. Temperature at the caruncle, medial and lateral conjunctiva was noted to be significantly higher in the active TED group compared to inactive TED and healthy eyes. The most favorable Youden index (0.7) was noted for the caruncle with an AUROC value of 0.91, a sensitivity of 91% and a specificity of 79%. Correlation coefficient for the caruncular temperature with the corresponding CAS (clinical activity score) was 0.65 (95% C.I. 0.45 to 0.78, p < .0001).Conclusion: Thermal imaging in TED is an objective way of documenting surface inflammation by the surrogate marker of temperature change. It supplements CAS in clinically evident cases and could be useful in staging eyes with subtle clinical signs as well as those where signs have reduced following initiation of treatment.
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Affiliation(s)
- Tarjani Vivek Dave
- Ophthalmic Plastic Surgery Service, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Palash Patodi
- Ophthalmic Engineering Department, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Ashutosh Richhariya
- Ophthalmic Engineering Department, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
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Yuksel N, Unal O, Mutlu M, Ergeldi G, Caglayan M. Real-time ultrasound elastographic evaluation of extraocular muscle involvement in Graves' ophthalmopathy. Orbit 2019; 39:160-164. [PMID: 31296093 DOI: 10.1080/01676830.2019.1639770] [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: 10/26/2022]
Abstract
Purpose: To evaluate the affected extraocular muscles (EOMs) of patients with Graves' ophthalmopathy (GO) using real-time ultrasound elastography (UE) and to compare these results with those of healthy subjects.Methods: This prospective, comparative case series included 70 eyes of 35 patients with moderate-to-severe GO with type 2 orbitopathy (myogenic variant) according to their computed tomography (CT) scans. Forty-six eyes of 23 healthy subjects were evaluated as the control group. The strain ratio of orbital fat to medial rectus was calculated as the ratio of the medial rectus to orbital fat tissue, and the strain ratio of orbital fat to lateral rectus was calculated as the ratio of lateral rectus to orbital fat tissue.Results: The strain ratio of orbital fat to medial rectus was 3.03 ± 1.25 (range: 1.05-5.07) in the GO group, and 0.54 ± 0.20 (range: 0.14-1.08) in the control group (p = .0001). The strain ratio of orbital fat to lateral rectus was 0.97 ± 0.29 (range: 0.56-1.55) in the GO group, and 0.63 ± 0.23 (range: 0.18-1.09) in the control group (p = .0001).Conclusion: By using real-time UE, we found the medial and the lateral recti of GO patients to be stiffer compared to those of healthy subjects.
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Affiliation(s)
- Nilay Yuksel
- Ophthalmology Department, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Ozlem Unal
- Radiology Department, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | | | - Gulcin Ergeldi
- Ophthalmology Department, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Mehtap Caglayan
- Ophthalmology Department, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
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Lai FHP, Iao TWU, Ng DSC, Young AL, Leung J, Au A, Ko STC, Chong KKL. Choroidal thickness in thyroid-associated orbitopathy. Clin Exp Ophthalmol 2019; 47:918-924. [PMID: 31034694 DOI: 10.1111/ceo.13525] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/25/2019] [Accepted: 04/22/2019] [Indexed: 12/14/2022]
Abstract
IMPORTANCE To investigate the choroidal thickness (CT) in patients with thyroid-associated orbitopathy (TAO). BACKGROUND To compare CT of TAO patients and healthy subjects. DESIGN Prospective cross-sectional study in a public hospital. PARTICIPANTS One hundred and four eyes of 52 TAO patients and 52 eyes of 26 healthy subjects. METHODS CT was measured with enhanced-depth imaging optical coherence tomography (EDI-OCT) at the subfoveal, macular and peripapillary regions. Multivariate linear regression was used to evaluate the associations of subfoveal CT with systemic and ocular variables among TAO eyes. MAIN OUTCOME MEASURES CT of both groups. RESULTS CT of eyes with TAO was significantly increased at the subfoveal region, 1 and 2 mm from the fovea nasally, temporally and superiorly, and 1 mm inferior to the fovea (all P < .05). No significant difference was found in CT at 2 mm inferior to the fovea (P = .094) and all four quadrants of the peripapillary region (superior, P = .096; nasal, P = .732; inferior, P = .179; temporal, P = .052). Among TAO eyes, thinner subfoveal choroid was associated with worsening exophthalmos (P = .043), poorer visual acuity (P = .017), increasing age (P = .040) and axial length (P < .001). There was no association between CT and clinical activity score (P = .239). CONCLUSIONS AND RELEVANCE TAO patients showed thicker choroid than controls over the macula, but not the peripapillary regions. Thinner subfoveal choroid was associated with worsening exophthalmos and poorer vision. EDI-OCT can monitor choroidal vascular changes associated with TAO and its complications.
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Affiliation(s)
- Frank H P Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Tiara W U Iao
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Danny S C Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology, Hong Kong Eye Hospital, Hong Kong
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Joy Leung
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
| | - Alvin Au
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
| | - Simon T C Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
| | - Kelvin K L Chong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
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Choi KJ, Lee MJ. Comparison of exophthalmos measurements: Hertel exophthalmometer versus orbital parameters in 2-dimensional computed tomography. Can J Ophthalmol 2018; 53:384-390. [DOI: 10.1016/j.jcjo.2017.10.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 08/01/2017] [Accepted: 10/24/2017] [Indexed: 12/28/2022]
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Lo C, Ugradar S, Rootman D. Management of graves myopathy: Orbital imaging in thyroid-related orbitopathy. J AAPOS 2018; 22:256.e1-256.e9. [PMID: 30055270 DOI: 10.1016/j.jaapos.2018.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
Abstract
A broad understanding of the different imaging modalities used to assess the physiologic changes seen in Graves' orbitopathy complement clinical examination. Subtle applications of radiographic imaging techniques allow for a better understanding of the overall physiology of the orbit, quantify progression of disease, and differentiate it from orbital diseases with overlapping features. A nuanced approach to interpreting imaging features may allow us to delineate inactive from active thyroid eye disease, and advances within this field may arm clinicians with the ability to better predict and prevent dysthyroid optic neuropathy.
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Affiliation(s)
- Christopher Lo
- Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye institutes, University of California, Los Angeles
| | - Shoaib Ugradar
- Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye institutes, University of California, Los Angeles
| | - Daniel Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye institutes, University of California, Los Angeles.
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Orbital flourine-18-fluorodeoxyglucose positron emission tomography in patients with Graves’ disease for evaluation of active inflammation. Nucl Med Commun 2017; 38:964-970. [DOI: 10.1097/mnm.0000000000000737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Reyhan M, Toygar O, Sukan A, Seydaoglu G, Bakiner OS, Aydin M, Yapar AF, Aktas A. 99mTc(V)-DMSA SPECT for the assessment of disease activity in Graves' ophthalmopathy. Nucl Med Commun 2007; 28:775-81. [PMID: 17728607 DOI: 10.1097/mnm.0b013e3282e7d746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the use of 99mTc(V)-dimercaptosuccinic acid (99mTc(V)-DMSA) scintigraphy for the assessment of disease activity in patients with Graves' ophthalmopathy (GO) and compare their clinical parameters. METHODS The study involved 20 patients who were clinically inactive and eight patients who were clinically active, a total 28 GO patients (18 female, 10 male; mean age: 39.2+/-13.4 years) and 12 control subjects (six female, six male; mean age: 57.12+/-12 years). Planar and SPECT orbital images were obtained 4 h after the intravenous injection of 555-740 MBq 99mTc(V)-DMSA, using low-energy, high-resolution, parallel-hole collimators with dual-head detectors. All SPECT data were reconstructed on conventional axial, sagittal and coronal projections using an iterative reconstruction. Semi-quantitative evaluation was performed comparing the orbital activity with nasal activity based on four grades. GO was classified according to the NOSPECS classification of the American Thyroid Association. Disease was considered clinically active if symptoms and signs deteriorated over 3 months. RESULTS No significant correlation was detected between clinical activity and classification (P=0.192). However, clinical activity and 99mTc(V)-DMSA uptake were significantly correlated (P=0.0001). There was no correlation between the clinical classification and scintigraphic grading. Bilateral orbital index of the active group was significantly higher than that of the inactive group (P=0.0001). CONCLUSION 99mTc(V)-DMSA imaging discriminates the active from inactive GO as well as showing an ongoing subclinical inflammation in the orbits of the patients with GO, regardless of the disease activity clinically. Our results revealed that 99mTc(V)-DMSA is a promising agent for the diagnosis of active Graves' ophthalmopathy.
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Affiliation(s)
- Mehmet Reyhan
- Department of Nuclear Medicine, Baskent University Faculty of Medicine, Ankara, Turkey.
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