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Wong AS, Chelnis JG. Systematic review of ocular surface treatments in the setting of thyroid eye disease. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1352355. [PMID: 38984136 PMCID: PMC11199852 DOI: 10.3389/fopht.2024.1352355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/29/2024] [Indexed: 07/11/2024]
Abstract
Introduction Approximately 85% of patients with thyroid eye disease experience ocular surface symptoms. Although corneal exposure plays a role in inducing inflammatory changes to the ocular surface, multiple studies reveal more complexity to the abnormal tear film composition and parameters in thyroid eye disease patients including those who do not have proptosis or increased corneal exposure. Currently, a majority of cases of thyroid associated dry eye symptoms are given treatments intended for ocular surface disease arising from different etiologies. Methods Medline via Ovid, Cochrane CENTRAL, PubMed, and Google Scholar were systematically searched for articles evaluating the efficacy of treatments for dry eye symptoms in patients with thyroid eye disease. Articles were from all geographic regions and dates ranged from inception until October 2023. Results Seven papers ultimately met inclusion criteria and were included in this review. These papers revealed that multiple topical and non-topical treatment modalities address dry eye symptoms in thyroid eye disease and improve subjective and objective ocular surface parameters. However, due to the few studies that exist and due to disparities in sample size and study design, no overwhelming best practices were identified that could influence clinical practice. Conclusion This systematic review identifies the current treatments that exist and highlights the clear unmet need for a large population suffering with dry eye symptoms. Ideally, further well-designed investigations into this area would target topical, non-invasive modalities to develop first line options for thyroid eye disease patients.
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Affiliation(s)
- Anthony Stephen Wong
- Department of Ophthalmology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, United States
| | - James G Chelnis
- Manhattan Face and Eye, New York, NY, United States
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States
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Qi CX, Wen Z, Huang X. Altered functional connectivity strength of primary visual cortex in subjects with thyroid-associated ophthalmopathy. Neuroreport 2024; 35:568-576. [PMID: 38652513 DOI: 10.1097/wnr.0000000000002039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Our objective was to explore the disparities in the intrinsic functional connectivity (FC) patterns of primary visual cortex (V1) between patients with thyroid-associated ophthalmopathy (TAO) and healthy controls (HCs) utilizing resting-state functional MRI. Twenty-one patients with TAO (14 males and 7 females; mean age: 54.17 ± 4.83 years) and 21 well-matched HCs (14 males and 7 females; mean age: 55.17 ± 5.37 years) underwent functional MRI scans in the resting-state. We assessed modifications in the intrinsic FC patterns of the V1 in TAO patients using the FC method. Subsequently, the identified alterations in FC regions in the analysis were selected as classification features to distinguish TAO patients from HCs through the support vector machine (SVM) method. The results indicated that, in comparison to HCs, patients with TAO exhibited notably reduced FC values between the left V1 and the bilateral calcarine (CAL), lingual gyrus (LING) and superior occipital gyrus, as well as between the right V1 and the bilateral CAL/LING and the right cerebellum. Furthermore, the SVM classification model based on FC maps demonstrated effective performance in distinguishing TAO patients from HCs, achieving an accuracy of 61.9% using the FC of the left V1 and 64.29% using the FC of the right V1. Our study revealed that patients with TAO manifested disruptions in FC between the V1 and higher visual regions during rest. This might indicate that TAO patients could present with impaired top-down modulations, visual imagery and vision-motor function. These insights could be valuable in understanding the underlying neurobiological mechanisms of vision impairment in individuals with TAO.
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Affiliation(s)
- Chen-Xing Qi
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University
| | - Zhi Wen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan
| | - Xin Huang
- Department of Ophthalmology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Zhang H, Liu Y, Xia D, Jiang M, Li Y, Sun J, Guan H, Zhu L, Song X, Wang J, Fan X, Zhou H. The insular cortex is not insular in thyroid eye disease: neuroimaging revelations of central-peripheral system interaction. J Neuroinflammation 2024; 21:51. [PMID: 38368427 PMCID: PMC10874024 DOI: 10.1186/s12974-024-03044-4] [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: 08/31/2023] [Accepted: 02/13/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Thyroid eye disease (TED) is highly correlated with dysregulated immunoendocrine status. The insular cortex was found to regulate peripheral inflammation and immunomodulation in mice. This study aimed to explore whether the insular cortex in patients with TED played a modulatory role including the aberrant brain functional alteration and its association with immunoendocrine status. METHODS This study included 34 active patients (AP), 30 inactive patients (IP) with TED, and 45 healthy controls (HC) matched for age, sex, and educational level. Comprehensive clinical details (especially immunoendocrine markers) and resting-state functional magnetic resonance imaging data were collected from each participant. The amplitude of low-frequency fluctuation (ALFF) was used to probe the aberrant alterations of local neural activity. The seed-based functional connectivity (FC) analysis was used to explore the relationship between the insular cortex and each voxel throughout the whole brain. The correlation analysis was conducted to assess the association between insular neurobiomarkers and immunoendocrine parameters. RESULTS When compared with the IP and HC groups, the AP group displayed significantly higher ALFF values in the right insular cortex (INS.R) and lower FC values between the INS.R and the bilateral cerebellum. None of the neurobiomarkers differed between the IP and HC groups. Besides, correlations between insular neurobiomarkers and immunoendocrine markers (free thyroxine, the proportion of T cells, and natural killer cells) were identified in both AP and IP groups. CONCLUSIONS This study was novel in reporting that the dysregulation of the insular cortex activity in TED was associated with abnormal peripheral immunoendocrine status. The insular cortex might play a key role in central-peripheral system interaction in TED. Further research is crucial to enhance our understanding of the central-peripheral system interaction mechanisms involved in autoimmune diseases.
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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
| | - Yuting Liu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Duojin Xia
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Mengda Jiang
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinwei Li
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jing Sun
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Haixia Guan
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Ling Zhu
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 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
| | - Jue Wang
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China.
| | - Xianqun 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.
| | - 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.
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Lei C, Qu M, Sun H, Huang J, Huang J, Song X, Zhai G, Zhou H. Facial expression of patients with Graves' orbitopathy. J Endocrinol Invest 2023; 46:2055-2066. [PMID: 37005981 DOI: 10.1007/s40618-023-02054-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/27/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Patients with Graves' orbitopathy (GO) have characteristic facial expressions that are different from those of healthy individuals due to the combination of somatic and psychiatric symptoms. However, the facial expressions of GO patients have not yet been described and analyzed systematically. Thus, the present study aimed to present the facial expressions of GO patients and explore their applications in clinical practice. METHODS Facial image and clinical data of 943 GO patients were included, and 126 patients answered quality of life (GO-QOL) questionnaires. Each patient was labeled for one facial expression. Then, a portrait was drawn for every facial expression. Logistic and linear regression was performed to analyze the correlation between facial expression and clinical indicators, including QOL, disease activity and severity. The VGG-19 network model was utilized to discriminate facial expressions automatically. RESULTS Two groups, i.e., the non-negative emotion (neutral, happy) and the negative emotion (disgust, angry, fear, sadness, surprise), and seven expressions of GO patients were systematically analyzed. Facial expression was statistically associated with GO activity (P = 0.002), severity (P < 0.001), QOL visual functioning subscale scores (P = 0.001), and QOL appearance subscale score (P = 0.012). The deep learning model achieved satisfactory results (accuracy 0.851, sensitivity 0.899, precision 0.899, specificity 0.720, F1 score 0.899, and AUC 0.847). CONCLUSIONS As a novel clinical sign, facial expression holds the potential to be incorporated into GO assessment system in the future. The discrimination model may assist clinicians in real-life patient care.
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Affiliation(s)
- C Lei
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - M Qu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - H Sun
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - J Huang
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - J Huang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - X Song
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
| | - G Zhai
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - H Zhou
- Department of Ophthalmology, 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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Huang Y, Li K, Yan Y, He J, Chen J. Strabismus surgery for improving the quality of life of strabismus patients with thyroid-associated ophthalmopathy. Medicine (Baltimore) 2023; 102:e34778. [PMID: 37657062 PMCID: PMC10476816 DOI: 10.1097/md.0000000000034778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/26/2023] [Indexed: 09/03/2023] Open
Abstract
Thyroid-associated ophthalmopathy (TAO) is an autoimmune disease involving the ocular tissues that may require strabismus surgery treatment. Presently, little is known about the impact of strabismus surgery on the quality of life of such patients. Consequently, the aim of the present study was to explore the effect of strabismus surgery on the quality of life of strabismus patients with quiescent TAO. This was a prospective case-series study. Strabismus patients with TAO who were admitted to the First Affiliated Hospital of Guangxi Medical University for strabismus surgery from October 2011 to April 2016 were included in this study. The included patients were asked to complete the Graves' ophthalmopathy quality of life questionnaire (GO-QOL) before strabismus surgery and 6 weeks after the surgery, respectively. Preoperative and postoperative GO-QOL scores were compared using the paired samples t-test. The correlation between strabismus surgery and the quality of life was analyzed using Spearman correlation analysis. In total, 23 patients, with a mean age of 49.04 years old, were included in the study. Compared to the preoperative GO-QOL scores, the postoperative scores of these patients for visual function (43.04 vs 73.50, P < .001) and psychosocial function (40.13 vs 72.93, P < .001) were both significantly increased. The greater the preoperative angle of misalignment of the eyes, the worse the psychosocial function (r = -0.433, P = .039). Strabismus surgery can significantly improve the quality of life of strabismus patients with quiescent TAO.
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Affiliation(s)
- Yihua Huang
- Department of Ophthalmology, Wuming School of Clinical Medicine of Guangxi Medical University, Wuming Hospital of Guangxi Medical University, Nanning, China
| | - Kaijun Li
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuqing Yan
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jianfeng He
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinmao Chen
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Lee TC, Radha-Saseendrakumar B, Delavar A, Ye GY, Ting MA, Topilow NJ, Bass J, Korn BS, Kikkawa DO, Baxter SL, Liu CY. Evaluation of Depression and Anxiety in a Diverse Population With Thyroid Eye Disease Using the Nationwide NIH All of Us Database. Ophthalmic Plast Reconstr Surg 2023; 39:281-287. [PMID: 36727790 DOI: 10.1097/iop.0000000000002318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the prevalence of depression and anxiety among individuals with thyroid eye disease (TED) and identify sociodemographic risk factors using the NIH All of Us database. METHODS Three hundred ninety eight cases with TED were compared with 1,592 controls with demographics matching the 2020 US Census. Primary outcomes were diagnosed depression or anxiety; Patient Health Questionnaire-9 (PHQ-9) scores and General Anxiety Disorder-7 (GAD-7) scores were included as secondary outcomes. We performed multivariable logistic regression to generate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between TED and depression and anxiety. RESULTS Patients with TED were more likely to have depression (OR 2.72, 95% CI 2.08-3.56, p < 0.001) and anxiety (OR 2.82, 95% CI 2.16-3.70, p < 0.001) than controls. In patients with TED, female gender was an independent risk factor for both depression (OR 1.72; 95% CI 1.00-5.07, p = 0.05) and anxiety (OR 2.17, 95% CI 1.25-3.85, p = 0.006). Unemployment (OR 1.72, 95% CI 1.03-2.94, p = 0.04) and lower income (OR 0.88 for income as a continuous variable, 95% CI 0.79-0.99, p = 0.03) were risk factors for anxiety. Risk factors for more severe depression as assessed by PHQ-9 included lower income (OR 0.70, 95% CI 0.57-0.85, p < 0.001), and protective factors included Black race (OR 0.12, 95% CI 0.02-0.45, p = 0.002). Lower income was associated with more severe anxiety as assessed by GAD-7 (OR 0.77, 95% CI 0.64-0.94, p = 0.009). CONCLUSIONS Patients with TED were more likely to develop depression and anxiety compared with controls. This study highlights the psychosocial impact of TED and associated socioeconomic risk factors.
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Affiliation(s)
- Tonya C Lee
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
| | - Bharanidharan Radha-Saseendrakumar
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Arash Delavar
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Gordon Y Ye
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Michelle A Ting
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Nicole J Topilow
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Jeremy Bass
- Department of Psychiatry, University of California San Diego, La Jolla, California, U.S.A
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Sally L Baxter
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
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Chen YY, Wei YH, Liao SL. Postoperative residual vertical deviation affects quality of life in Asian patients with thyroid-associated ophthalmopathy (Graves ophthalmopathy). Jpn J Ophthalmol 2023; 67:326-334. [PMID: 37079164 DOI: 10.1007/s10384-023-00990-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 03/09/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE To evaluate the treatment effect of strabismus surgery for Graves ophthalmopathy in an ethnic Chinese population. STUDY DESIGN A prospective clinical study. METHODS Thirty-one patients with Graves ophthalmopathy who had undergone strabismus surgery at National Taiwan University Hospital between 2012 and 2013 were consecutively recruited. The subjective outcome was evaluated using the Graves' Ophthalmopathy Quality-of-Life (GO-QoL) questionnaire, and the ocular deviation was measured preoperatively and postoperatively by use of a prism cover test. RESULTS The GO-QoL scores for visual functioning and appearance improved significantly after surgery (preoperative scores 32.6 ± 19.9 and 43.8 ± 26.4, postoperative scores 55.2 ± 24.4 and 54.1 ± 27.6, respectively; P < .05). Motor success was achieved in 61.3% of the patients, and their postoperative visual scores were higher (61.5 ± 22.5) than the scores of those who experienced motor failure (45.3 ± 26.8, P = .048). The postoperative visual function scores showed a negative correlation with the residual vertical deviation (R2 = 0.546, P = .040). A higher increase in GO-QoL visual scores and a lower residual vertical deviation in downgaze were achieved among patients without previous decompression surgery. Our surgical methods resulted in a motor success rate of 76.5% for the correction of vertical deviation. CONCLUSION GO-QoL scores and ocular deviation improved significantly after strabismus surgery. Precise correction of vertical deviation was of greater importance than horizontal deviation for visual function scores. Our surgical methods were effective for the correction of vertical deviation in Graves ophthalmopathy.
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Affiliation(s)
- Ying-Yi Chen
- Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan
- Department of Ophthalmology, Sijhih Cathay General Hospital, New Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Hsuan Wei
- Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Lang Liao
- Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Araya J, Sabharwal S, Briceño CA. Surgery in Thyroid Eye Disease. Int Ophthalmol Clin 2023; 63:91-107. [PMID: 36963830 DOI: 10.1097/iio.0000000000000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
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Jellema HM, Eckstein A, Oeverhaus M, Lacraru I, Saeed P. Incidence of A pattern strabismus after inferior rectus recession in patients with Graves' orbitopathy: A retrospective multicentre study. Acta Ophthalmol 2023; 101:e106-e112. [PMID: 35934887 PMCID: PMC10087168 DOI: 10.1111/aos.15223] [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: 04/19/2022] [Revised: 07/01/2022] [Accepted: 07/19/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION AND PURPOSE Patients with Graves' orbitopathy (GO) may develop restricted elevation; this can lead to hypotropia, sometimes in combination with an abnormal head posture. Recession of one or both inferior rectus muscles is the first line surgery to restore eye motility in these patients. However, this may result in A pattern strabismus. This study was performed to determine the rate of occurrence of this type of incomitant strabismus and potential predictive factors. METHODS All patients undergoing surgery on one or two inferior rectus muscles over a 10-year period were screened retrospectively for the A pattern, defined as a ≥5° difference in squint angle between the primary gaze and downgaze. The extraocular muscle thickness in patients with acquired A pattern was determined by computed tomography (CT) and compared with a control group consisting of patients randomly selected from the total cohort. RESULTS In a total of 590 patients, surgery was performed on the inferior rectus muscle(s) during the study period; the A pattern was identified in 59 patients. Simultaneous surgery was performed on one or both medial rectus muscles in 32% of the patients. This group had significant incyclotorsion (p = 0.000) and less depression (p = 0.000) postoperatively. The mean amount of recession was 4.38 ± 1.53 mm in the A pattern group and 3.91 ± 1.37 mm in the control group (p = 0.032). The amount of depression was 50.2° ± 7.4° in the A pattern group and 57.3° ± 4.4° in the control group (p = 0.045). The inferior rectus muscle was significantly thicker in the A pattern than in the control group (p = 0.027), while there was no significant difference in the thickness of the superior oblique muscle between the two groups (p = 0.870). Of all patients with the A pattern, 47% required further surgery to achieve adequate binocular single vision. CONCLUSION Increased preoperative inferior rectus muscle thickness and relatively limited depression could be predictors of postoperative A pattern inferior rectus recession in patients with GO. Step-by-step procedures are preferable in this surgically challenging group of patients.
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Affiliation(s)
- Hinke Marijke Jellema
- Orbital Center, Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anja Eckstein
- University Eye Hospital, University Duisburg Essen, Essen, Germany
| | | | - Ioana Lacraru
- Orbital Center, Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Peerooz Saeed
- Orbital Center, Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Song Y, Wang X, Ma W, Yang Y, Yan S, Sun J, Zhu X, Tang Y. Graves' disease as a driver of depression: a mechanistic insight. Front Endocrinol (Lausanne) 2023; 14:1162445. [PMID: 37152963 PMCID: PMC10157224 DOI: 10.3389/fendo.2023.1162445] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/05/2023] [Indexed: 05/09/2023] Open
Abstract
Graves' disease (GD) is characterized by diffuse enlargement and overactivity of the thyroid gland, which may be accompanied by other physical symptoms. Among them, depression can dramatically damage patients' quality of life, yet its prevalence in GD has not received adequate attention. Some studies have established a strong correlation between GD and increased risk of depression, though the data from current study remains limited. The summary of mechanistic insights regarding GD and depression has underpinned possible pathways by which GD contributes to depression. In this review, we first summarized the clinical evidence that supported the increased prevalence of depression by GD. We then concentrated on the mechanistic findings related to the acceleration of depression in the context of GD, as mounting evidence has indicated that GD promotes the development of depression through various mechanisms, including triggering autoimmune responses, inducing hormonal disorders, and influencing the thyroid-gut-microbiome-brain axis. Finally, we briefly presented potential therapeutic approaches to decreasing the risk of depression among patients with GD.
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Affiliation(s)
- Yifei Song
- Beijing University of Chinese Medicine, Beijing, China
| | - Xinying Wang
- Beijing University of Chinese Medicine, Beijing, China
| | - Wenxin Ma
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yan Yang
- Tongling Municipal hospital, Anhui, China
| | - Shuxin Yan
- Beijing University of Chinese Medicine, Beijing, China
| | - Jiapan Sun
- Department of Geriatrics, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong, China
- *Correspondence: Jiapan Sun, ; Xiaoyun Zhu, ; Yang Tang,
| | - Xiaoyun Zhu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Jiapan Sun, ; Xiaoyun Zhu, ; Yang Tang,
| | - Yang Tang
- Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Jiapan Sun, ; Xiaoyun Zhu, ; Yang Tang,
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Wang Y, Shao Y, Zhang H, Wang J, Zhang P, Zhang W, Chen H. Comprehensive analysis of key genes and pathways for biological and clinical implications in thyroid-associated ophthalmopathy. BMC Genomics 2022; 23:630. [PMID: 36056316 PMCID: PMC9440526 DOI: 10.1186/s12864-022-08854-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background Thyroid-associated ophthalmopathy (TAO) is a common and organ-specific autoimmune disease. Early diagnosis and novel treatments are essential to improve the prognosis of TAO patients. Therefore, the current work was performed to identify the key genes and pathways for the biological and clinical implications of TAO through comprehensive bioinformatics analysis and a series of clinical validations. Methods GSE105149 and GSE185952 were obtained from the Gene Expression Omnibus (GEO) database for analysis. The data were normalized to identify the common differentially expressed genes (DEGs) between the two datasets, and the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted to assess key pathways in TAO. Protein–protein interaction (PPI) networks and hub genes among the common DEGs were identified. Furthermore, we collected the general information and blood samples from 50 TAO patients and 20 healthy controls (HCs), and the expression levels of the proteins encoded by hub genes in serum were detected by enzyme-linked immunosorbent assay (ELISA). Then we further assessed the relationship between the ELISA data and the TAO development. Results Several common pathways, including neuroactive ligand-receptor interaction, the IL-17 signaling pathway, and the TNF signaling pathway, were identified in both datasets. In parallel, 52 common DEGs were identified. The KEGG analysis showed that these common DEGs are mainly enriched in long-term depression, the VEGF signaling pathway, the IL-17 signaling pathway, the TNF signaling pathway, and cytokine-cytokine receptor interactions. The key hub genes PRKCG, OSM, DPP4, LRRTM1, CXCL6, and CSF3R were screened out through the PPI network. As confirmation, the ELISA results indicated that protein expression levels of PRKCG, OSM, CSF3R, and DPP4 were significantly upregulated in TAO patients compared with HCs. In addition, PRKCG and DPP4 were verified to show value in diagnosing TAO, and CSF3R was found to be a valuable diagnostic marker in distinguishing active TAO from inactive TAO. Conclusions Inflammation- and neuromodulation-related pathways might be closely associated with TAO. Based on the clinical verification, OSM, CSF3R, CXCL6, DPP4, and PRKCG may serve as inflammation- or neuromodulation-related biomarkers for TAO, providing novel insights for the diagnosis and treatment of TAO. Supplementary Information The online version contains supplementary material available at 10.1186/s12864-022-08854-5.
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Affiliation(s)
- Yueyue Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanfei Shao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haitao Zhang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Wang
- Department of Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Peng Zhang
- Department of Ophthalmology, The Friendship Hospital of Ili Kazakh Autonomous Prefecture Ili & Jiangsu Joint Institute of Health, Ili, China
| | - Weizhong Zhang
- Department of Ophthalmology, The Friendship Hospital of Ili Kazakh Autonomous Prefecture Ili & Jiangsu Joint Institute of Health, Ili, China. .,Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Huanhuan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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12
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Zhou J, Chen W, Wu Q, Chen L, Chen HH, Liu H, Xu XQ, Wu FY, Hu H. Reduced cortical complexity in patients with thyroid-associated ophthalmopathy. Brain Imaging Behav 2022; 16:2133-2140. [PMID: 35821157 DOI: 10.1007/s11682-022-00683-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/02/2022]
Abstract
Psychical and functional disturbances of thyroid-associated ophthalmopathy (TAO) patients are drawing increasingly attention, despite the characterized ophthalmic symptoms. We aimed to investigate the alterations of structural complexity using fractal dimension (FD) analysis in patients with TAO. Thirty-nine TAO patients and 25 healthy controls underwent high-resolution 3.0 T structural brain magnetic resonance imaging (MRI). FD values of brain regions were calculated by Computational Anatomy Toolbox (CAT12) and compared between groups. The associations between clinical variables and FD values were further estimated. We found that TAO patients exhibited significantly decreased FD values in right caudal anterior cingulate cortex, right lingual gyrus, right pars orbitalis and right cuneus cortex (FDR corrected p < 0.05). FD values of right cuneus cortex were positively correlated with visual acuity, and FD values of right caudal anterior cingulate cortex were also positively correlated with cognitive performance. Meanwhile, FD values of right lingual gyrus were found to be negatively correlated with emotional function. Our study indicated disturbed cortical complexity in brain regions corresponding to known functional deficits of vision, emotion and cognition in TAO. FD might be a potential marker for reflecting the underlying neurobiological basis of TAO.
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Affiliation(s)
- Jiang Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, 210029, China
| | - Wen Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, 210029, China
| | - Qian Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, 210029, China
| | - Lu Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, 210029, China
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, 210029, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, 210029, China.
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, 210029, China.
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Qi CX, Wen Z, Huang X. Reduction of Interhemispheric Homotopic Connectivity in Cognitive and Visual Information Processing Pathways in Patients With Thyroid-Associated Ophthalmopathy. Front Hum Neurosci 2022; 16:882114. [PMID: 35865354 PMCID: PMC9295451 DOI: 10.3389/fnhum.2022.882114] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Thyroid-associated ophthalmopathy (TAO) is a vision threatening autoimmune and inflammatory orbital disease, and has been reported to be associated with a wide range of structural and functional abnormalities of bilateral hemispheres. However, whether the interhemisphere functional connectivity (FC) of TAO patients is altered still remain unclear. A new technique called voxel-mirrored homotopic connectivity (VMHC) combined with support vector machine (SVM) method was used in the present study to explore interhemispheric homotopic functional connectivity alterations in patients with TAO. Methods A total of 21 TAO patients (14 males and 7 females) and 21 wellmatched healthy controls (HCs, 14 males and 7 females), respectively, underwent functional magnetic resonance imaging (fMRI) scanning in the resting state. We evaluated alterations in the resting state functional connectivity between hemispheres by applying VMHC method and then selected these abnormal brain regions as seed areas for subsequent study using FC method. Furthermore, the observed changes of regions in the VMHC analysis were chosen as classification features to differentiate patients with TAO from HCs through support vector machine (SVM) method. Results The results showed that compared with HCs, TAO patients showed significantly lower VMHC values in the bilateral postcentral gyrus, lingual gyrus, calcarine, middle temporal gyrus, middle occipital gyrus and angular. Moreover, significantly decreased FC values were found between the right postcentral gyrus/lingual gyrus/calcarine and left lingual gyrus/cuneus/superior occipital gyrus, left postcentral gyrus/lingual gyrus/calcarine and right lingual gyrus/ middle temporal gyrus, right middle temporal gyrus and left cerebellum-8/lingual gyrus/middle occipital gyrus/supplementary motor area, left middle temporal gyrus and right middle occipital gyrus, right middle occipital gyrus/angular and left middle temporal pole (voxel-level p < 0.01, Gaussian random field correction, cluster-level p < 0.05). The SVM classification model achieved good performance in differentiating TAO patients from HCs (total accuracy: 73.81%; area under the curve: 0.79). Conclusion The present study revealed that the altered interhemisphere interaction and integration of information involved in cognitive and visual information processing pathways including the postcentral gyrus, cuneus, cerebellum, angular, widespread visual cortex and temporal cortex in patients with TAO relative to HC group. VMHC variability had potential value for accurately and specifically distinguishing patients with TAO from HCs. The new findings may provide novel insights into the neurological mechanisms underlying visual and cognitive disorders in patients with TAO.
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Affiliation(s)
- Chen-Xing Qi
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zhi Wen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xin Huang
- Department of Ophthalmology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang University, Nanchang, China
- *Correspondence: Xin Huang
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14
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Luo L, Wen H, Gao L, Li R, Wang S, Wang Z, Li D. Morphological brain changes between active and inactive phases of thyroid associated ophthalmopathy: a voxel-based morphometry study. Brain Res 2022; 1790:147989. [PMID: 35738426 DOI: 10.1016/j.brainres.2022.147989] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/02/2022]
Abstract
AIM To explore the morphological brain changes among active thyroid-associated ophthalmopathy (TAO) patients, inactive TAO patients and healthy controls and to investigate the neuropathological relationship of TAO using magnetic resonance imaging (MRI) data. METHODS In this observational case-control study, we included 35 inactive TAO patients, 37 active TAO patients and 23 healthy controls. Voxel-based morphometry (VBM) analysis was conducted to evaluate the gray matter volume (GMV) changes among groups, and the correlations between GMV alterations and clinical parameters in active and inactive TAO groups were investigated. RESULTS Active TAO patients showed significantly increased GMV in the right inferior frontal gyrus, left superior frontal gyrus (SFG), orbital superior frontal gyrus, orbital middle frontal gyrus, precuneus and postcentral gyrus compared with controls and significantly increased GMV in the right middle temporal gyrus, left SFG and precuneus compared with the inactive TAO group. No significant differences were observed between the inactive TAO group and healthy controls. Notably, the receiver operating characteristic (ROC) curve analysis demonstrated altered GMV among groups and significantly (p<0.001) differentiated active TAO from inactive TAO and healthy controls. In addition, the mean GMV in precuneus and postcentral gyrus were significantly associated with clinical parameters in active TAO. CONCLUSION Our findings suggested the localized GMV alterations among groups were associated with the pathophysiology of TAO and served as a potential discriminative pattern to detect clinical phases of TAO at the individual level. The altered brain morphometry may suggest a corresponding process of self-repair and remodeling of the brain structure as the disease progresses in TAO.
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Affiliation(s)
- Lihua Luo
- Department of Ophthalmology, Beijing Friendship Hospital,Capital Medical University, Beijing, China
| | - Hongwei Wen
- Key Laboratory of Cognition and Personality (Ministry of Education), Faculty of Psychology, Southwest University, Chongqing, China
| | - Lixin Gao
- Department of Ophthalmology, Beijing Friendship Hospital,Capital Medical University, Beijing, China
| | - Rui Li
- Department of Radiology,Beijing Friendship Hospital,Capital Medical University, Beijing, China
| | - Shengpei Wang
- Research Center for Brain-inspired Intelligence Institute of Automation, Chinese Academy of Sciences, ZhongGuanCun East Rd. 95#, Beijing, 100190
| | - Zhenchang Wang
- Department of Radiology,Beijing Friendship Hospital,Capital Medical University, Beijing, China.
| | - Donmei Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China.
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Wang Y, Padnick-Silver L, Francis-Sedlak M, Holt RJ, Foley C, Douglas RS. Inflammatory and non-inflammatory thyroid eye disease: comparison of disease signs, symptoms and quality of life in US patients. Endocr Pract 2022; 28:842-846. [PMID: 35714862 DOI: 10.1016/j.eprac.2022.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Thyroid eye disease (TED) is an autoimmune, inflammatory disease resulting in retro-orbital fat and extraocular muscle expansion. TED quiets ("inactivates") as inflammation wanes, but signs/symptoms often persist. Disease signs/symptoms and quality of life (QOL) impact were examined in non-inflammatory and inflammatory TED. METHODS Moderate-to-severe TED patient data were collected from treating physicians. Clinical activity score (CAS, 6/7 measures available) assessed TED as inflammatory (CAS≥3) or non-inflammatory (CAS=0-1). QOL impact was scored as 1="not at all impaired" to 7="extremely impaired." Non-inflammatory TED patients were further grouped into longer (>3 years) and shorter (≤3 years) disease. RESULTS Inflammatory (N=307) and non-inflammatory (N=281) patients had comparable age (50.0±13.3, 48.3±13.8 years), sex (66%, 64% female), TED duration (4.0±4.9; 4.6±5.5 years), and proportion smokers (15%, 11%). Most common non-inflammatory TED signs/symptoms included ocular dryness/grittiness (77%), proptosis (56%), excessive tearing (43%), soft tissue edema (42%), conjunctival redness (24%) decreased vision (24%) and eye muscle involvement (22%; 14% had diplopia). All were less reported than in patients with inflammatory TED. QOL was impacted by non-inflammatory TED, but to a lesser degree than inflammatory disease (3.6±1.5 vs. 4.7±1.4). However, mental health issues were similarly reported. Non-inflammatory TED patients with longer disease (9.0±6.0 years) had similar QOL impact, mental health diagnoses, and TED sign/symptoms as those with shorter disease (1.4±1.0 years). CONCLUSION TED signs/symptoms often chronically persist long after TED has "quieted," continuing to impact patient QOL and mental health. These data suggest that moderate-to-severe TED should be thought of as a robust symptomatic chronic disease, regardless of inflammatory status.
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Affiliation(s)
- Yao Wang
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | | | | | | | | | - Raymond S Douglas
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
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16
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Tang W, Lv Q, Huang X, Li Y, Zou J, Zheng J, Sun L, Bao Y, Chen H, Li T, Zhang B, Xue S, Song Y, Zhang X, Chen X, Cai J, Shi Y. MiR-143 Targets IGF-1R to Suppress Autoimmunity in Thyroid-Associated Ophthalmopathy. J Inflamm Res 2022; 15:1543-1554. [PMID: 35256853 PMCID: PMC8898058 DOI: 10.2147/jir.s339483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/27/2022] [Indexed: 12/13/2022] Open
Abstract
Objective Thyroid-associated ophthalmopathy (TAO) is an autoimmune disease that involves the remodeling of orbit and periorbital tissues. Thyroid-stimulating hormone receptor (TSHR) and insulin-like growth factor 1 receptor (IGF-1R) may stimulate the activation of autoimmunity in TAO, but the exact mechanism is unclear. We investigated whether IGF-1R/TSHR modulation in TAO may involve microRNA regulation. Methods We conducted microarray analysis using RNA from the orbital connective tissue samples of 3 healthy and 3 patients with TAO. The involvement of differentially regulated microRNA in IGF-1R/TSHR modulation in TAO was evaluated in orbital fibroblasts (OFs) and female BALB/c mice. Results Using hierarchical cluster analysis, we identified that miR-143 was downregulated in TAO. The expression levels of miR-143 in OFs were significantly reduced under IL-1B stimulation. However, OF proliferation and inflammatory responses decreased when miR-143 is overexpressed. In contrast, the suppression of miR-143 increased levels of inflammatory markers (IL-6, IL-8, MCP1) and hyaluronan accumulation. Moreover, overexpression of miR-143 significantly lowers levels of IGF-1R and TSHR. A luciferase assay indicated that miR-143 targets the 3′-UTR of IGF-1R. Increases in the expression of IGF-1R increased the expression of the inflammasome marker NLRP3 and apoptotic marker cleaved caspase-1; however, miR-143 overexpression decreased levels of IGF-1R, TSHR, NLRP3, cleaved caspase 1, IL-1B, and IL-18. In a mouse model of TAO, overexpression of miR-143 significantly reduced levels of IGF-1R and attenuated the adipogenesis associated with TAO. Conclusion We found that miR-143 directly targets IGF-1R to alleviate the inflammatory response in TAO by indirectly decreasing levels of TSHR and inactivating NLRP3.
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Affiliation(s)
- Wei Tang
- Department of Endocrinology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Qian Lv
- Department of Endocrinology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Xiao Huang
- Department of Ophthalmology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Yuzhen Li
- Department of Ophthalmology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - JunJie Zou
- Department of Endocrinology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Jiaoyang Zheng
- Department of Endocrinology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Liangliang Sun
- Department of Endocrinology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Yi Bao
- Department of Endocrinology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Haiyan Chen
- Department of Endocrinology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Tuo Li
- Department of Endocrinology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Bei Zhang
- Department of Endocrinology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Song Xue
- Department of Endocrinology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Yan Song
- Department of Endocrinology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Xingxing Zhang
- Department of Endocrinology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Xiangfang Chen
- Department of Endocrinology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
- Correspondence: Xiangfang Chen; Yongquan Shi, Department of Endocrinology, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Huangpu District, Shanghai, 200003, People’s Republic of China, Email ;
| | - Jiping Cai
- Department of Ophthalmology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Yongquan Shi
- Department of Endocrinology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
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Zhao RX, Shi TT, Luo S, Liu YF, Xin Z, Yang JK. The value of SPECT/CT imaging of lacrimal glands as a means of assessing the activity of Graves' orbitopathy. Endocr Connect 2022; 11:e210590. [PMID: 35015696 PMCID: PMC8859942 DOI: 10.1530/ec-21-0590] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/11/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Graves' orbitopathy (GO) is an autoimmune disease with mechanical impairment of orbital muscles and lacrimal gland dysfunction. The frequently used methods of assessing GO activity include Clinical Activity Score (CAS), CT, and MRI. These approaches are mainly associated with orbital muscles; however, there are not many studies that focus on the lacrimal gland inflammation of GO patients. OBJECTIVE The aim of this study is to assess the usefulness of 99mTc-DTPA single-photon emission (SPE) CT/CT in evaluating the lacrimal gland inflammation in GO, as compared with other methods. METHODS A retrospective analysis of 48 patients with active GO compared with 33 controls was conducted. All subjects underwent clinical-endocrinological analyses, CAS evaluation, CT scans, and SPECT/CT examination. Lacrimal gland dimensions were determined and analyzed. RESULTS The lacrimal glands in patients with GO were significantly larger in all measured dimensions (P < 0.001) on CT scans relative to those in controls. Increased lacrimal gland diethylene triamine pentaacetic acid (DTPA) uptake ratios (P < 0.001) were displayed in active GO patients compared to controls and were also correlated with thyrotropin receptor antibody levels. The cut-off value for discriminating active and inactive disease was calculated to be 1.735, with specificity of 82.6% and sensitivity of 74.2%. SPECT/CT uptake ratios and CAS values were positively correlated in all GO patients. SPECT/CT uptake ratios were also positively correlated with CT measurements including lacrimal gland volume and coronal width in GO patients. CONCLUSIONS These data indicated that lacrimal gland SPECT/CT images can serve as a good tool for assessing the inflammation and disease activity of GO.
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Affiliation(s)
- Ru-Xuan Zhao
- Department of Endocrinology, Beijing Diabetes Institute, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ting-Ting Shi
- Department of Endocrinology, Beijing Diabetes Institute, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Sha Luo
- Department of Nuclear Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yun-Fu Liu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhong Xin
- Department of Endocrinology, Beijing Diabetes Institute, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jin-Kui Yang
- Department of Endocrinology, Beijing Diabetes Institute, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Correspondence should be addressed to J-K Yang:
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Chen W, Hu H, Wu Q, Chen L, Zhou J, Chen HH, Xu XQ, Wu FY. Altered Static and Dynamic Interhemispheric Resting-State Functional Connectivity in Patients With Thyroid-Associated Ophthalmopathy. Front Neurosci 2021; 15:799916. [PMID: 34938158 PMCID: PMC8685321 DOI: 10.3389/fnins.2021.799916] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: Thyroid-associated ophthalmopathy (TAO) is a debilitating and sight-threatening autoimmune disease that severely impairs patients' quality of life. Besides the most common ophthalmic manifestations, the emotional and psychiatric disturbances are also usually observed in clinical settings. This study was to investigate the interhemispheric functional connectivity alterations in TAO patients using resting-state functional magnetic resonance imaging (rs-fMRI). Methods: Twenty-eight TAO patients and 22 healthy controls (HCs) underwent rs-fMRI scans. Static and dynamic voxel-mirrored homotopic connectivity (VMHC) values were calculated and compared between the two groups. A linear support vector machine (SVM) classifier was used to examine the performance of static and dynamic VMHC differences in distinguishing TAOs from HCs. Results: Compared with HCs, TAOs showed decreased static VMHC in lingual gyrus (LG)/calcarine (CAL), middle occipital gyrus, postcentral gyrus, superior parietal lobule, inferior parietal lobule, and precuneus. Meanwhile, TAOs demonstrated increased dynamic VMHC in orbitofrontal cortex (OFC). In TAOs, static VMHC in LG/CAL was positively correlated with visual acuity (r = 0.412, P = 0.036), whilst dynamic VMHC in OFC was positively correlated with Hamilton Anxiety Rating Scale (HARS) score (r = 0.397, P = 0.044) and Hamilton Depression Rating Scale (HDRS) score (r = 0.401, P = 0.042). The SVM model showed good performance in distinguishing TAOs from HCs (area under the curve, 0.971; average accuracy, 94%). Conclusion: TAO patients had altered static and dynamic VMHC in the occipital, parietal, and orbitofrontal areas, which could serve as neuroimaging prediction markers of TAO.
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Affiliation(s)
- Wen Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lu Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiang Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Cockerham KP, Padnick-Silver L, Stuertz N, Francis-Sedlak M, Holt RJ. Quality of Life in Patients with Chronic Thyroid Eye Disease in the United States. Ophthalmol Ther 2021; 10:975-987. [PMID: 34478126 PMCID: PMC8589903 DOI: 10.1007/s40123-021-00385-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Thyroid eye disease (TED) is an autoimmune condition producing ocular pain, dysmotility, and ocular structure and function changes. As disease activity changes, redness, swelling, and pain can improve, but eye comfort, appearance, and motility alterations often persist. There are limited data on chronic TED patient-reported outcomes. This study examined chronic US TED patient-reported symptoms and quality of life (QOL). METHODS Existing data from an online survey regarding chronic TED signs/symptoms and patient QOL were retrospectively examined. The Graves' Ophthalmopathy QOL instrument (GO-QOL; 0-100, 100 = highest QOL) evaluated overall, appearance, and vision-related QOL. Influencing factors were examined by stratifying patients into low (overall QOL ≤ 50), moderate (> 50 and < 75), and high (≥ 75) QOL categories. RESULTS One hundred patients (47 women, 81 Caucasian, 45.2 ± 7.6 years) were included. The duration of inactive TED was 3.0 ± 4.6 years and total duration of TED was 5.8 ± 5.9 years. Patients reported an average of 20 doctor visits/year and high prevalence of anxiety (34%) and depression (28%). Prior TED treatments for the polled population included systemic corticosteroids during active TED (25%), orbital radiation (5%), and surgery (25%). The overall GO-QOL score was 60.5 ± 21.8 (vision-related: 58.6 ± 24.0, appearance-related: 62.3 ± 25.1). Patients with low QOL more frequently reported hypothyroidism, anxiety, and a larger number of chronic TED signs/symptoms (average: 4.2). Compared to high QOL patients, low QOL patients had more pain (39% vs. 13%), blurry vision (30% vs. 17%), and diplopia (27% vs. 3%, all p ≤ 0.025). Additionally, the low QOL group more often had TED-specific surgical history (45% vs. 10%, p = 0.002), more often reported disability/unemployment (21% vs. 3%, p = 0.055), and had a higher number of doctor visits (40 vs. 5 visits/person/year, p < 0.001). CONCLUSION TED severely impacts patient QOL, despite becoming stable and chronic. Patients reported vision and appearance impairment and psychosocial impact long after acute TED had subsided.
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Affiliation(s)
- Kimberly P. Cockerham
- Central Valley Eye Medical Group, 36 W Yokuts Avenue, Suite 2, Stockton, CA 95207 USA
- Department of Ophthalmology, Stanford School of Medicine, 2454 Watson Court, Palo Alto, CA 94303 USA
| | | | - Noel Stuertz
- Horizon Therapeutics plc, 1 Horizon Way, Deerfield, IL 60015 USA
| | | | - Robert J. Holt
- Horizon Therapeutics plc, 1 Horizon Way, Deerfield, IL 60015 USA
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Draman MS, Zhang L, Dayan C, Ludgate M. Orbital Signaling in Graves' Orbitopathy. Front Endocrinol (Lausanne) 2021; 12:739994. [PMID: 34899596 PMCID: PMC8660111 DOI: 10.3389/fendo.2021.739994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Graves' orbitopathy (GO) is a complex and poorly understood disease in which extensive remodeling of orbital tissue is dominated by adipogenesis and hyaluronan production. The resulting proptosis is disfiguring and underpins the majority of GO signs and symptoms. While there is strong evidence for the thyrotropin receptor (TSHR) being a thyroid/orbit shared autoantigen, the insulin-like growth factor 1 receptor (IGF1R) is also likely to play a key role in the disease. The pathogenesis of GO has been investigated extensively in the last decade with further understanding of some aspects of the disease. This is mainly derived by using in vitro and ex vivo analysis of the orbital tissues. Here, we have summarized the features of GO pathogenesis involving target autoantigens and their signaling pathways.
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Affiliation(s)
- Mohd Shazli Draman
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff, United Kingdom
- KPJ Healthcare University College, Nilai, Malaysia
| | - Lei Zhang
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Colin Dayan
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Marian Ludgate
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff, United Kingdom
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Draman MS, Grennan-Jones F, Taylor P, Muller I, Evans S, Haridas A, Morris DS, Rees DA, Lane C, Dayan C, Zhang L, Ludgate M. Expression of Endogenous Putative TSH Binding Protein in Orbit. Curr Issues Mol Biol 2021; 43:1794-1804. [PMID: 34889904 PMCID: PMC8928972 DOI: 10.3390/cimb43030126] [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: 06/24/2021] [Revised: 10/05/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
Thyroid stimulating antibodies (TSAB) cause Graves’ disease and contribute to Graves’ Orbitopathy (GO) pathogenesis. We hypothesise that the presence of TSH binding proteins (truncated TSHR variants (TSHRv)) and/or nonclassical ligands such as thyrostimulin (α2β5) might provide a mechanism to protect against or exacerbate GO. We analysed primary human orbital preadipocyte-fibroblasts (OF) from GO patients and people free of GO (non-GO). Transcript (QPCR) and protein (western blot) expression levels of TSHRv were measured through an adipogenesis differentiation process. Cyclic-AMP production by TSHR activation was studied using luciferase-reporter and RIA assays. After differentiation, TSHRv levels in OF from GO were significantly higher than non-GO (p = 0.039), and confirmed in ex vivo analysis of orbital adipose samples. TSHRv western blot revealed a positive signal at 46 kDa in cell lysates and culture media (CM) from non-GO and GO-OF. Cyclic-AMP decreased from basal levels when OF were stimulated with TSH or Monoclonal TSAB (M22) before differentiation protocol, but increased in differentiated cells, and was inversely correlated with the TSHRv:TSHR ratio (Spearman correlation: TSH r = −0.55, p = 0.23, M22 r = 0.87, p = 0.03). In the bioassay, TSH/M22 induced luciferase-light was lower in CM from differentiated GO-OF than non-GO, suggesting that secreted TSHRv had neutralised their effects. α2 transcripts were present but reduced during adipogenesis (p < 0.005) with no difference observed between non-GO and GO. β5 transcripts were at the limit of detection. Our work demonstrated that TSHRv transcripts are expressed as protein, are more abundant in GO than non-GO OF and have the capacity to regulate signalling via the TSHR.
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Affiliation(s)
- Mohd Shazli Draman
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
- KPJ Healthcare University College, Kota Seriemas, Nilai 71800, Malaysia
| | - Fiona Grennan-Jones
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
| | - Peter Taylor
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
| | - Ilaria Muller
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Department of Endocrinology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 28, 20122 Milan, Italy
| | - Sam Evans
- Department of Ophthalmology, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK; (S.E.); (A.H.); (D.S.M.); (C.L.)
| | - Anjana Haridas
- Department of Ophthalmology, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK; (S.E.); (A.H.); (D.S.M.); (C.L.)
| | - Daniel S. Morris
- Department of Ophthalmology, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK; (S.E.); (A.H.); (D.S.M.); (C.L.)
| | - D. Aled Rees
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
| | - Carol Lane
- Department of Ophthalmology, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK; (S.E.); (A.H.); (D.S.M.); (C.L.)
| | - Colin Dayan
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
| | - Lei Zhang
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
- Correspondence: ; Tel.: +44-292-074-2343; Fax: +44-292-0744-671
| | - Marian Ludgate
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK; (M.S.D.); (F.G.-J.); (P.T.); (I.M.); (D.A.R.); (C.D.); (M.L.)
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22
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Outcomes of Graves' Disease Patients Following Antithyroid Drugs, Radioactive Iodine, or Thyroidectomy as the First-line Treatment. Ann Surg 2021; 273:1197-1206. [PMID: 33914484 DOI: 10.1097/sla.0000000000004828] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The long-term outcomes of first-line choice among ATD, RAI, and thyroidectomy for GD patients remain unclear. OBJECTIVE To compare the long-term morbidity, mortality, relapse, and costs of GD patients receiving first-line treatment. METHODS A population-based retrospective cohort of GD patients initiating first-line treatment with ATD, RAI, or thyroidectomy as a first-line primary treatment between 2006 and 2018 from Hong Kong Hospital Authority was analyzed. Risks of all-cause mortality, CVD, AF, psychological disease, diabetes, and hypertension were estimated using Cox proportional hazards regression models. The 10-year healthcare costs, change of comorbidities, and risk of relapse were compared across treatments. RESULTS Over a median follow-up of 90 months with 47,470 person-years, 6385 patients (ATD, 74.93%; RAI, 19.95%; thyroidectomy, 5.12%) who received first-line treatment for GD were analyzed. Compared with ATD group, patients who had undergone surgery had significantly lower risks of all-cause mortality [hazard ratio (HR) = 0.363, 95% confidence interval (CI) = 0.332-0.396], CVD (HR = 0.216, 95% CI = 0.195-0.239), AF (HR = 0.103, 95% CI = 0.085-0.124), psychological disease (HR = 0.279, 95% CI = 0.258-0.301), diabetes (HR = 0.341, 95% CI = 0.305-0.381), and hypertension (HR = 0.673, 95% CI = 0.632-0.718). Meanwhile, RAI group was also associated with decreased risks of all-cause mortality (HR = 0.931, 95% CI = 0.882-0.982), CVD (HR = 0.784, 95% CI = 0.742-0.828), AF (HR = 0.622, 95% CI = 0.578-0.67), and psychological disease (HR = 0.895, 95% CI = 0.855-0.937). The relapse rate was 2.41% in surgery, 75.60% in ATD, and 19.53% in RAI group. The surgery group was observed with a significant lower Charlson Comorbidity Index score than the other 2 groups at the tenth-year follow-up. The mean 10-year cumulative healthcare costs in ATD, RAI, and surgery group was US$23915, US$24260, and US$20202, respectively. CONCLUSIONS GD patients who received surgery as an initial treatment appeared to have lower chances of all-cause mortality, CVD, AF, psychological disease, diabetes, and hypertension in the long-term when compared to those treated with ATD or RAI. The surgery group had the lowest relapse and direct healthcare costs among the 3 treatment modalities. This long-term cohort study suggested surgery may have a larger role to play as an initial treatment for GD patients.
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Zhang SY, Li J, Liu R, Lao HY, Fan Z, Jin L, Liang L, Liu Y. Association of Allergic Conjunctivitis With Health-Related Quality of Life in Children and Their Parents. JAMA Ophthalmol 2021; 139:830-837. [PMID: 34110380 DOI: 10.1001/jamaophthalmol.2021.1708] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Allergic conjunctivitis (AC) is one of the most common allergic diseases and is especially problematic in children and adolescents. The course of AC is generally prolonged and often recurs. Understanding the health-related quality of life (QOL) of both children with AC and their parents would be useful. Objective To evaluate the association between AC and health-related QOL in children and their parents. Design, Setting, and Participants A prospective case-control study was conducted at Zhongshan Ophthalmic Center, a single tertiary referral center, from November 16, 2019, through January 20, 2020. Participants comprised 92 children aged 5 to 18 years with AC and their parents and 96 healthy, age-matched children who served as controls and their parents. The 92 children in the AC group were subdivided into cohorts with vernal keratoconjunctivitis (VKC) (23 [25.0%]) or atopic keratoconjunctivitis (AKC) (7 [7.6%]) and seasonal allergic conjunctivitis (SAC) (26 [28.3%]) or perennial allergic conjunctivitis (PAC) (36 [39.1%]). Exposures Allergic conjunctivitis. Main Outcomes and Measures Pediatric Quality of Life Inventory, version 4.0 (PedsQL), scores for children and their parents. Scores range from 0 to 100, with higher scores indicating better health-related QOL and fewer negative aspects. Results In the AC group, 77 of 92 (83.7%) participants were boys, and 67 (72.8%) of the parents were women. Of the individuals in the control group, 55 of 96 (57.3%) of the children were girls and 76 (79.2%) of the parents were women. Median total PedsQL scores were reduced in both children with AC (69.6 [interquartile range [IQR], 66.3-72.8 vs 96.7; IQR, 92.7-98.9; P < .001) and their parents (68.8; IQR, 63.9-71.4 vs 96.5; IQR, 95.1-97.9; P < .001). The reduction in health-related QOL was more severe in children with VKC/AKC than in those with SAC/PAC (difference, -3.3; 95% CI, -5.4 to -1.1; P = .004) and their parents (difference, -4.3; 95% CI, -7.1 to -2.1; P < .001). In the AC group, a higher corneal fluorescein staining score was associated with lower QOL in children (β, -1.16; 95% CI, -1.80 to -0.52; P = .001); higher corneal fluorescein staining scores (β, -1.12; 95% CI, -1.74 to -0.50; P = .001) and multiple clinical consultations (β, -3.96; 95% CI, -7.34 to -0.57; P = .02) were associated with lower QOL in parents. The parents' QOL scores were correlated with their children's QOL scores (correlation coefficient, r = 0.59; P < .001). Conclusions and Relevance These findings suggest AC has a negative association with health-related QOL for children and their parents, especially in children with VKC/AKC or higher corneal fluorescein staining scores.
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Affiliation(s)
- Shi-Yao Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ren Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hubert Yuenhei Lao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zixin Fan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lingyi Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Chen W, Wu Q, Chen L, Zhou J, Chen HH, Xu XQ, Hu H, Wu FY. Disrupted Spontaneous Neural Activity in Patients With Thyroid-Associated Ophthalmopathy: A Resting-State fMRI Study Using Amplitude of Low-Frequency Fluctuation. Front Hum Neurosci 2021; 15:676967. [PMID: 34177495 PMCID: PMC8226248 DOI: 10.3389/fnhum.2021.676967] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The purpose of the study was to investigate the brain functional alteration in patients with thyroid-associated ophthalmopathy (TAO) by evaluating the spontaneous neural activity changes using resting-state functional magnetic resonance imaging (rs-fMRI) with the amplitude of low-frequency fluctuation (ALFF) method. MATERIALS AND METHODS The rs-fMRI data of 30 TAO patients (15 active and 15 inactive) and 15 healthy controls (HCs) were included for analyses. The ALFF values were calculated and compared among groups. Correlations between ALFF values and clinical metrics were assessed. RESULTS Compared with HCs, active TAOs showed significantly decreased ALFF values in the left middle occipital gyrus, superior occipital gyrus, and cuneus. Compared with inactive TAOs, active TAOs showed significantly increased ALFF values in the bilateral precuneus. Additionally, inactive TAOs showed significantly decreased ALFF values in the left middle occipital gyrus, superior occipital gyrus, cuneus, and bilateral precuneus than HCs. The ALFF value in the right precuneus of TAOs was positively correlated with clinical activity score (r = 0.583, P < 0.001) and Mini-Mental State Examination (MMSE) score (r = 0.377, P = 0.040), and negatively correlated with disease duration (r = -0.382, P = 0.037). Moreover, the ALFF value in the left middle occipital gyrus of TAOs was positively correlated with visual acuity (r = 0.441, P = 0.015). CONCLUSION TAO patients had altered spontaneous brain activities in the left occipital lobe and bilateral precuneus. The neuropsychological aspect of the disease should be noticed during clinical diagnosis and treatment.
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Affiliation(s)
- Wen Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lu Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiang Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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25
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Luisa V, Riccardo T, Stefano P, Manlio G. Effectiveness of orbital decompression for endocrine orbitopathy and impact on quality of life: A retrospective study. J Craniomaxillofac Surg 2021; 49:867-874. [PMID: 34218976 DOI: 10.1016/j.jcms.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 02/11/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022] Open
Abstract
To evaluate the effectiveness of orbital decompression intervention in terms of variation of the exophthalmos and to highlight its association with changes in quality of life before and after surgery. Medical records of patients with moderate-severe GO who underwent orbital decompression surgery were retrospectively reviewed. Clinical parameters, including demographic characteristics, surgical technique, exophthalmos values, and QoL using the GO-QoL questionnaire were studied before and after orbital decompression and analyzed. Thirty patients were included in the study. Surgery was bilateral 26 patients and unilateral in 4 patients (56 operated orbits). Before surgery the average value of exophthalmometry was 24.96 (±2.68) mm. The questionnaires submitted for assessment of the quality of life (GO-QoL) yielded average values of 43.3 for the visual function (VF) and 44.03 for the appearance (AP). 20 patients (64.3%) underwent combined bone and fat decompression surgery, 9 underwent fat decompression, and 1 underwent bone decompression. After surgery, the average values of exophthalmometry were 21.8 (±2.34) mm, with an average reduction of 3.20 (±2.35) mm. (p < 0.0001) GO-QoL questionnaires administered after surgery showed a mean VF score of 76.73 (±26.75), and AP score of 73.71 (±21.89). (p < 0.001, paired t-test) Orbital decompressive surgery is not only effective on GO, but also on a long-term improvement in overall well-being, self-confidence and QoL.
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Affiliation(s)
- Valente Luisa
- Unit of Cranio Maxillo Facial Surgery, Center for Craniofacial Deformities & Orbital Surgery - Reference Center for Rare Disease, Sant'Anna Hospital and University, Cona, Ferrara, Italy
| | - Tieghi Riccardo
- Unit of Cranio Maxillo Facial Surgery, Center for Craniofacial Deformities & Orbital Surgery - Reference Center for Rare Disease, Sant'Anna Hospital and University, Cona, Ferrara, Italy.
| | | | - Galiè Manlio
- Unit of Cranio Maxillo Facial Surgery, Center for Craniofacial Deformities & Orbital Surgery - Reference Center for Rare Disease, Sant'Anna Hospital and University, Cona, Ferrara, Italy
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Chen W, Wu Q, Chen L, Zhou J, Chen HH, Xu XQ, Wu FY, Hu H. Aberrant brain voxel-wise resting state fMRI in patients with thyroid-associated ophthalmopathy. J Neuroimaging 2021; 31:773-783. [PMID: 33817897 DOI: 10.1111/jon.12858] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Although ophthalmic complaints were mostly mentioned in thyroid-associated ophthalmopathy (TAO), emotional and psychological disturbances are increasingly concerned. We aimed to investigate the brain functional alteration in TAO patients by using resting-state functional MRI (rs-fMRI) with the fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), and degree centrality (DC) methods. METHODS Twenty-one consecutive TAO patients and 21 healthy controls (HCs) underwent rs-fMRI scans. The fALFF, ReHo, and DC values were compared between groups. RESULTS Compared with HCs, TAO group showed decreased fALFF values in bilateral calcarine/left lingual gyrus and left middle occipital gyrus (MOG). Moreover, TAO group had decreased ReHo values in left MOG/inferior occipital gyrus/fusiform gyrus, while increased ReHo values in bilateral middle frontal gyrus (MFG)/superior frontal gyrus (SFG) than HCs. TAO group also showed decreased DC values in bilateral postcentral gyrus (PoCG)/precentral gyrus/superior parietal lobule and supplementary motor area, and increased DC values in left SFG/MFG and MFG. In TAO patients, ReHo value in left MOG was positively correlated with visual acuity (r = 0.524, p = 0.021), while ReHo values in bilateral MFGs were negatively correlated with cognitive scores (left/right: r = -0.476/-0.527, p = 0.039/0.020). DC value in left PoCG was negatively correlated with disease duration (r = -0.492, p = 0.033). CONCLUSIONS Our findings indicated that TAO patients had brain functional alterations in the visual network, executive control network, sensorimotor network, and attention network, which may reflect potential visual and cognitive dysfunctions.
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Affiliation(s)
- Wen Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lu Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiang Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Wu Q, Hu H, Chen W, Chen HH, Chen L, Zhou J, Liu H, Wu FY, Xu XQ. Disrupted Topological Organization of the Brain Structural Network in Patients With Thyroid-Associated Ophthalmopathy. Invest Ophthalmol Vis Sci 2021; 62:5. [PMID: 33821882 PMCID: PMC8039468 DOI: 10.1167/iovs.62.4.5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose Increasing evidence indicated that thyroid-associated ophthalmopathy (TAO) might be a neural related disease more than an ocular disease. In this study, we aimed to investigate the alterations of structural brain connectome in patients with TAO. Methods Twenty-seven patients with TAO and 27 well-matched healthy controls underwent diffusion tensor imaging. Graph theoretical analyses, including global (shortest path length, clustering coefficient, small-worldness, global efficiency, and local efficiency) and nodal (nodal betweenness, nodal degree, and nodal efficiency) topological properties and network-based statistics were performed to evaluate TAO-related changes in brain network pattern. Correlations were assessed between the network properties and clinical variables, including disease duration, visual acuity, neuropsychiatric measurements, and serum thyroid function indexes. Results Compared with healthy controls, patients with TAO exhibited preserved global network parameters but altered nodal properties. We found decreased nodal betweenness and nodal degree in right anterior cingulate and paracingulate gyri, decreased nodal degree and nodal efficiency in the right orbital part of middle frontal gyrus (ORBmid), whereas increased nodal degree and nodal efficiency in the left cuneus. Decrease of structural connectivity strength was found involving the right ORBmid, right putamen, left caudate nucleus, and left medial superior frontal gyrus. Significant correlations were also found between nodal properties and neuropsychological performances as well as visual acuity. Conclusions Patients with TAO developed disruption of structural brain network connectome. Disrupted topological organization of the brain structural network may be associated with the clinical-psychiatric dysfunction of patients with TAO.
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Affiliation(s)
- Qian Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wen Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lu Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiang Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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28
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Wang Y, Sharma A, Padnick-Silver L, Francis-Sedlak M, Holt RJ, Foley C, Massry G, Douglas RS. Trends in Treatment of Active, Moderate-to-Severe Thyroid Eye Disease in the United States. J Endocr Soc 2020; 4:bvaa140. [PMID: 33195953 PMCID: PMC7645612 DOI: 10.1210/jendso/bvaa140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/23/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Limited data exist on US referral/management patterns for moderate-to-severe thyroid eye disease (TED), a disabling condition. Methods US ophthalmologists and endocrinologists experienced in treating TED provided medical record data of moderate-to-severe TED patients and information on referral/treatment practices. Data on signs/symptoms, medical/surgical treatments, treatment response, and referral history were collected. Moderate and severe cases were stratified to interrogate treatment/practice differences. Results A total of 181 physicians provided data on 714 patients (49.4 ± 13.6 years old, 65% women, 14% severe disease). Reporting physicians diagnosed 55% of patients themselves and solely managed 37% of cases, with similar referral/comanagement patterns between moderate and severe cases. Topical therapies included lubricating (79%) and glucocorticoid (39%) eye drops. Systemic therapies included oral glucocorticoids (36%), IV glucocorticoids (15%), and rituximab and/or tocilizumab (12%). Few patients underwent orbital radiation (4%) or surgical intervention (4%). IV glucocorticoids (33% vs. 12%), biologics (26% vs. 10%), orbital radiation (11% vs. 3%), and ocular surgery (12% vs. 3%) were used more often in severe versus moderate cases (all P < 0.001). However, severe disease was less responsive to therapy (very responsive to therapy: 28% vs. 49%, P < 0.001). Conclusions Participating physicians were primarily responsible for just over one-half of TED diagnoses, but solely treated <40% of patients. Severe TED was treated more often with surgery and systemic immunologic therapies than moderate disease, but was less likely to respond to treatment. These results reinforce that moderate-to-severe TED is difficult to treat with an unmet medical need in the United States.
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Affiliation(s)
- Yao Wang
- Cedars Sinai Medical Center, Los Angeles, California
| | - Anu Sharma
- Division of Endocrinology, Diabetes and Metabolism, University of Utah School of Medicine, Salt Lake City, Utah
| | | | | | | | | | - Guy Massry
- Cedars Sinai Medical Center, Los Angeles, California
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Physician-Perceived Impact of Thyroid Eye Disease on Patient Quality of Life in the United States. Ophthalmol Ther 2020; 10:75-87. [PMID: 33196932 PMCID: PMC7886952 DOI: 10.1007/s40123-020-00318-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Thyroid eye disease (TED) is an autoimmune disease that causes retro-orbital inflammation and subsequent proptosis, corneal exposure, strabismus, and variable vision changes. European studies have shown that TED can severely impact quality of life (QOL), but little is known about the QOL of patients with TED in the USA. Given that patient QOL influences TED severity classifications and subsequent treatment, understanding physician-perceived patient QOL is extremely important. Methods This retrospective chart review (conducted in 2018) examined QOL in US patients with moderate-to-severe TED, as reported by treating physicians who regularly manage patients with TED (≥ 5 patients in prior 12 months). The physicians graded patients’ overall QOL (7-point Likert scale; 1 = “not at all impaired”, 7 = “extremely impaired”), assessing mental health, vision changes, and ocular structural signs/symptoms. Patient demographics and clinical findings were examined to understand the impact of disease presentation on physician-perceived QOL. Results Medical record data of 714 US patients with moderate-to-severe TED were provided by 181 physicians (73 endocrinologists, 108 ophthalmologists). Patients had a mean age of 49.4 (standard deviation [SD] 13.6) years, and 102 cases (14%) were severe. Anxiety and/or depression was reported in 36% of patients (an increase from the 18.9% prevalence reported for the USA in 2017 by the US National Institute of Mental Health; P < 0.001). The mean physician-reported QOL impact score was 4.1 (SD 1.5). Furthermore, 62 and 89% of patients with moderate and severe TED, respectively, had a high physician-perceived QOL impact (≥ 4). The higher QOL impact group had significantly higher rates of pain symptoms, visual disturbances (including diplopia), and orbito-facial structural changes. Higher disease activity and severity were associated with lower physician-perceived QOL. Conclusion Patients’ QOL, as evaluated by US physicians, is highly impacted by the activity and severity of TED. Additionally, mental health issues were more frequently reported by patients with TED than in the general US population. Ocular pain, strabismus, and diplopia appear to be main drivers of physician-perceived QOL impairment in this sample of US patients with TED. Little is known on how thyroid eye disease (TED) affects patient quality of life (QOL) in the USA. Patient QOL can affect how TED is treated; consequently, it is important to understand how physicians perceive QOL in patients with TED. We evaluated 714 patients, as reported by physicians, with this rare condition to better understand QOL in US patients with TED. The medical records of 612 patients with moderate TED and 102 patients with severe TED were examined. QOL impact was rated from 1 to 7, with 1 being “not at all impaired” and 7 being “extremely impaired.” Overall QOL, as assessed by treating physicians, is heavily impacted by both moderate and severe TED in US patients, with these patients also reported to have a higher frequency of mental health diagnoses than reported in the general US adult population. Higher levels of inflammation on and around the eye and more severe disease led to a higher QOL impairment. More specifically, pain, visual disturbances (including double vision), and changes to the face and tissues around the eye all negatively affected QOL.
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Chew CR, Chin SL, Lam T, Drosdowsky A, Chan STF, Chin-Lenn L. How does thyroidectomy for benign thyroid disease impact upon quality of life? A prospective study. ANZ J Surg 2020; 90:E177-E182. [PMID: 32975031 DOI: 10.1111/ans.16342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Choosing which patients to recommend surgery for benign thyroid conditions can be difficult due to the subjective nature of compressive thyroid and hormonal symptoms. The aim of this prospective study was to analyse changes in quality of life (QOL) following thyroid surgery using a validated disease-specific assessment tool, the thyroid-related patient-reported outcome (ThyPRO) questionnaire. METHODS Participants undergoing elective thyroid surgery for benign conditions were recruited. Patient demographics and clinical data were collected. ThyPRO consists of 85 questions grouped into 13 physical, mental and social symptom domains. Patients completed a ThyPRO questionnaire pre-operatively and at 6 weeks and 6 months post-operatively. ThyPRO items were scored according to protocol to produce 13 subscales. Repeated measures linear models with no random effects were performed using data for each outcome. RESULTS Results were available for a total of 72 patients. The sample was predominately female (n = 63, 88%) with average age 49.8 years. The majority of patients underwent surgery for multi-nodular goitre. At 6 weeks post-operatively, significant improvement was demonstrated in the goitre, hypothyroid, hyperthyroid and anxiety symptom domains. At 6 months post-operatively, significant improvement was demonstrated in all but four domains. No domains demonstrated significant increase in impairment post-operatively. CONCLUSION Patients had significant improvement in nine of 13 symptom domains following surgery. Patients did not experience a negative impact on QOL following surgery. Further studies with larger patient cohorts may be able to identify potential pre-operative predictive factors for a post-operative improvement in QOL for benign thyroid disease.
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Affiliation(s)
- Carolyn R Chew
- Endocrine Surgery, Department of Surgery, Western Hospital, Melbourne, Victoria, Australia
| | - Synn Lynn Chin
- Endocrine Surgery, Department of Surgery, Western Hospital, Melbourne, Victoria, Australia
| | - Tracey Lam
- Endocrine Surgery, Department of Surgery, Western Hospital, Melbourne, Victoria, Australia
| | - Allison Drosdowsky
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Steven T F Chan
- Department of Surgery, North West Academic Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Laura Chin-Lenn
- Endocrine Surgery, Department of Surgery, Western Hospital, Melbourne, Victoria, Australia
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Wu L, Li L, Liang Y, Chen X, Mou P, Liu G, Sun X, Qin B, Zhang S, Zhao C. Identification of differentially expressed long non-coding RNAs and mRNAs in orbital adipose/connective tissue of thyroid-associated ophthalmopathy. Genomics 2020; 113:440-449. [PMID: 32919017 DOI: 10.1016/j.ygeno.2020.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/15/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023]
Abstract
Extracellular matrix remodeling and orbital adipose/connective tissue expansion are two key features of thyroid-associated ophthalmopathy (TAO). Recent studies have indicated the critical role of long non-coding RNAs (lncRNAs) in the pathogenesis of ocular disorders. However, little is known about the roles of lncRNAs in orbital adipose/connective tissue of TAO. In this study, the profiles of lncRNAs and mRNAs in the orbital adipose/connective tissue of TAO were identified by RNA sequencing. A total of 809 differential lncRNAs and 607 differential mRNAs were identified, among which 52 genes were found to be significantly related to the extracellular matrix. Co-expression network analysis suggested that lncRNAs might regulate extracellular matrix remodeling in orbital adipose/connective tissue of TAO. Additionally, the target genes of lncRNAs involved in the lipid metabolism and cytokine-cytokine receptor interaction were also identified. These results may provide potential regulatory mechanisms of lncRNAs in the orbital adipose/connective tissue of TAO.
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Affiliation(s)
- Lianqun Wu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, 83 Fenyang Road, Shanghai 200031, China
| | - Lei Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, 83 Fenyang Road, Shanghai 200031, China
| | - Yu Liang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, 83 Fenyang Road, Shanghai 200031, China
| | - Xinxin Chen
- Department of Ophthalmology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 20003, China
| | - Pei Mou
- Department of Ophthalmology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 20003, China
| | - Guohua Liu
- Department of Ophthalmology, Qilu Children's Hospital of Shandong University, 430 Jingshi Road, Jinan 250022, China
| | - Xiantao Sun
- Department of Ophthalmolgoy, Children's Hospital Affiliated of Zhengzhou University, 255 Gangdu Road, Zhengzhou 450053, China
| | - Bing Qin
- Department of Ophthalmolgoy, Suqian First Hospital, 120 Suzhi Road, Suqian 223800, China
| | - Shujie Zhang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, 83 Fenyang Road, Shanghai 200031, China.
| | - Chen Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, 83 Fenyang Road, Shanghai 200031, China.
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Investigation of Meibomian Gland Function and Dry Eye Disease in Patients with Graves' Ophthalmopathy. J Clin Med 2020; 9:jcm9092814. [PMID: 32878140 PMCID: PMC7565905 DOI: 10.3390/jcm9092814] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 12/27/2022] Open
Abstract
We prospectively evaluated the relationship between meibomian gland dysfunction (MGD) and Graves’ ophthalmopathy (GO) in 19 patients (38 eyes) with subjective dry eye symptoms, compared to 14 age-matched normal participants (14 eyes). Extraocular muscle and lacrimal gland enlargement were evaluated by magnetic resonance imaging (MRI). Ocular surface examinations included fluorescein staining for keratoconjunctival epithelial damage, tear breakup time (TBUT) evaluation, and Schirmer’s test. Dry eye symptoms were evaluated with the Dry Eye-related Quality-of-Life Score (DEQS) questionnaire. Lid-margin abnormalities, meibum grade, and meiboscores were assessed using meibography. Clinical activity scores and T2 signal intensity ratios were used to define GO activity. All GO patients had obstructive MGD and 79% exhibited levator muscle enlargement. Ocular surface parameters of TBUT (p = 0.000), meibum score (p = 0.000), eyelid vasculitis (p = 0.000), meiboscore of the upper lid (p = 0.002), total meiboscores (p = 0.001), and DEQS (p = 0.000) significantly differed between GO patients and normal subjects. In addition, GO patients had significantly more abnormalities of the central region of the upper eyelid than normal subjects (p = 0.000). Thus, MGD might be related to eye discomfort and deterioration of the ocular surface in GO patients. Inflammation and morphological meibomian gland changes might be characteristic of GO.
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Zhang Y, Li X, Guo C, Dong J, Liao L. Mechanisms of Spica Prunellae against thyroid-associated Ophthalmopathy based on network pharmacology and molecular docking. BMC Complement Med Ther 2020; 20:229. [PMID: 32689994 PMCID: PMC7372882 DOI: 10.1186/s12906-020-03022-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thyroid-associated ophthalmopathy (TAO) is an autoimmune inflammatory disorder, which lacks effective treatment currently. Spica Prunellae (SP) is popularly used for its anti-inflammatory and immune-regulating properties, indicating SP may have potential therapeutic value in TAO. Therefore, the purpose of this study is to identify the efficiency and potential mechanism of SP in treating TAO. METHODS A network pharmacology integrated molecular docking strategy was used to predict the underlying molecular mechanism of treating TAO. Firstly, the active compounds of SP were obtained from TCMSP database and literature research. Then we collected the putative targets of SP and TAO based on multi-sources databases to generate networks. Network topology analysis, GO and KEGG pathway enrichment analysis were performed to screen the key targets and mechanism. Furthermore, molecular docking simulation provided an assessment tool for verifying drug and target binding. RESULTS Our results showed that 8 targets (PTGS2, MAPK3, AKT1, TNF, MAPK1, CASP3, IL6, MMP9) were recognized as key therapeutic targets with excellent binding affinity after network analysis and molecular docking-based virtual screening. The results of enrichment analysis suggested that the underlying mechanism was mainly focused on the biological processes and pathways associated with immune inflammation, proliferation, and apoptosis. Notably, the key pathway was considered as the PI3K-AKT signaling pathway. CONCLUSION In summary, the present study elucidates that SP may suppress inflammation and proliferation and promote apoptosis through the PI3K-AKT pathway, which makes SP a potential treatment against TAO. And this study offers new reference points for future experimental research and provides a scientific basis for more widespread clinical application.
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Affiliation(s)
- Yuhan Zhang
- Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250014, China.,Laboratory of Endocrinology, Medical Research Center, Shandong Provincial Qianfoshan Hospital, the First Affiliated Hospital of Shandong First Medical University, Jinan, 250014, Shandong, China
| | - Xianzhi Li
- Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250014, China.,Laboratory of Endocrinology, Medical Research Center, Shandong Provincial Qianfoshan Hospital, the First Affiliated Hospital of Shandong First Medical University, Jinan, 250014, Shandong, China
| | - Congcong Guo
- Department of Endocrinology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, China
| | - Jianjun Dong
- Division of Endocrinology, Department of Internal Medicine, Qilu Hospital of Shandong University, Jinan, 250012, China.
| | - Lin Liao
- Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250014, China. .,Department of Endocrinology and Metabology, the First Affiliated Hospital of Shandong First Medical University, Ji-nan, 250014, China.
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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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Park J, Baek S. Dry eye syndrome in thyroid eye disease patients: The role of increased incomplete blinking and Meibomian gland loss. Acta Ophthalmol 2019; 97:e800-e806. [PMID: 30593716 DOI: 10.1111/aos.14000] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/16/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE To compare the structure and function of the Meibomian gland and eyelid blinking patterns between thyroid eye disease (TED) patients with dry eye and nonthyroidal dry eye (DE) patients. METHODS This was a prospective, cross-sectional and observational study. Clinical measurements were performed as follows: (1) external examination, (2) Lipiview® Interferometer (lipid layer thickness, incomplete blinking rate and meibography) and (3) slit-lamp biomicroscopy (corneal staining, tear break-up time (TBUT), meibum expression). RESULTS The TED and DE groups included 98 and 62 patients, respectively. The meiboscores of the upper eyelid in TED and DE groups were significantly different (1.21 ± 0.76 and 0.94 ± 0.71, respectively, p = 0.046). The rate of incomplete blinking was 53.3 ± 34.5 and 34.6 ± 36.3%, respectively, and was significantly higher in the TED group (p = 0.006). In the TED group, CAS was the only variable affecting the meiboscore of the upper and lower eyelids (p = 0.031, 0.039, respectively). Significantly, active TED patients had more decreased basal tear secretion than inactive TED patients (7.4 ± 2.1 mm versus 8.5 ± 1.5 mm, p = 0.024). Moreover, active TED patients had decreased meibum expression in both upper and lower eyelids compared with inactive TED patients (2.20 ± 0.88 versus 1.08 ± 0.84, p = 0.002 in upper eyelid, 2.10 ± 0.88 versus 1.18 ± 0.88, p = 0.007 in lower eyelid, respectively). CONCLUSION In TED patients, incomplete blinking and loss of Meibomian gland structure in the upper eyelid were more prominent than in DE patients. CAS was a factor affecting the structural loss of Meibomian glands in TED individuals.
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Affiliation(s)
- Jinhwan Park
- Department of Ophthalmology Korea University College of Medicine Seoul Korea
| | - Sehyun Baek
- Department of Ophthalmology Korea University College of Medicine Seoul Korea
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[Evaluation by quality of life questionnaires in patients undergoing strabismus surgery in Graves' disease]. J Fr Ophtalmol 2018; 41:814-822. [PMID: 30217613 DOI: 10.1016/j.jfo.2017.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 12/20/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the improvement in quality of life of patients operated within 6 months for strabismus in Graves' disease using a questionnaire. MATERIALS AND METHODS A retrospective study was based on a cohort of patients undergoing strabismus surgery for Graves' disease at the Nancy university medical center between June 2015 and January 2017. A quality-of-life questionnaire composed of the functional GO QOL questionnaire plus 10 additional questions was given to patients. The questionnaires were completed by patients in consultation before surgery and then at six months postoperatively. A subgroup analysis was conducted to identify potential risk factors such as smoking, orbital decompression, duration of disease progression, number of surgeries, previous treatments or gender influences on the progression of the postoperative score. RESULTS Thirty-three patients (15 men/18 women) underwent surgery, with mean age 56 years; 16 (48 %) were smokers, 24 (70 %) were operated for the first time for strabismus. 8 patients (24 %) had a history of surgical orbital decompression. The mean preoperative GO QOLf was 30 (±23.8), which increased to 72 (±29.6) postoperatively (P=0.004). All the answers to the questions proposed were improved by surgery. The most improved items were difficulty in extreme gaze+6.82 points (P=0.001) and going down stairs +6.81 (P=0.002). Smokers had a lower preoperative GO QOLf than non-smokers (25±22.84 vs. 34±24.55); the same was true for their postoperative improvement (35±34.5 points vs. 50±18.8, P=0.002). History of orbital decompression did not appear to influence quality of life (21±25.39 vs. 65±33.98); the same was true for previous corticosteroid or immunosuppressant treatment (28±23.52 vs. 67±28.24), respectively P=0.42; P=0.73. Gender did not appear to influence the results P=0.17. First-time strabismus surgery patients showed a tendency which was not significant toward better improvement after 2 or 3 surgeries (respectively 45 vs. 39 vs. 33) P=0.056. There was no correlation between the duration of the disease and the change in the GO QOLf (R=0.04). CONCLUSION This study confirms that strabismus surgery significantly improves the quality of life of patients with Graves' ophthalmopathy. The GO QOLf demonstrates its effectiveness in highlighting this progression. Our ten additional questions proved to be very good tools for assessing this condition.
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Liao D, Ishii M, Darrach HM, Bater KL, Smith J, Joseph AW, Douglas RS, Joseph SS, Ishii LE. Objectively Measuring Observer Attention in Severe Thyroid-Associated Orbitopathy: A 3D Study. Laryngoscope 2018; 129:1250-1254. [PMID: 30151919 DOI: 10.1002/lary.27447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/23/2018] [Accepted: 06/20/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Measure the attentional distraction of facial deformity related to severe thyroid-associated orbitopathy using three-dimensional (3D) images and eye-tracking technology. METHODS Observers recruited at an academic tertiary referral center viewed 3D facial images of patients with severe thyroid-associated orbitopathy (TAO) and controls without TAO. An infrared eye-tracking monitor recorded their eye movements and fixations in real time. Multivariate Hotelling's analysis, followed by planned posthypothesis testing, was used to compare fixation durations for predefined regions of interest, including the eyes, nose, mouth, central triangle, and remaining face without the central triangle between severe TAO patients and controls. RESULTS One hundred sixteen observers (mean age 26.4 years, 51% female) successfully completed the eye-tracking experiment. The majority of their attention was directed toward the central triangle (eyes, nose, mouth). On multivariate analysis, there were significant differences in the distribution of attention between control and severe TAO faces (T2 = 49.37; F(5,922) = 9.8314, P < 0.0001). On planned posthypothesis testing, observers attended significantly more to the eyes (0.77 seconds, P < 0.0001, 95% confidence interval [CI], 0.51, 1.03 seconds) and less to the nose (-0.42 seconds, P < 0.0001, 95% CI, -0.23, -0.62 seconds) in severe TAO patients. There was no significant difference in time spent on the mouth, the total time spent on the central triangle, or time spent in the remaining face between the two groups. CONCLUSION Severe TAO distracted observer attention toward the eyes compared to control patients. These data lend insight into how TAO may alter observers' perceptions of these patients. Future studies should investigate how these changes in observer gaze patterns may reflect the social perception of TAO patients. LEVEL OF EVIDENCE NA Laryngoscope, 129:1250-1254, 2019.
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Affiliation(s)
- David Liao
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Halley M Darrach
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin L Bater
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jane Smith
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Andrew W Joseph
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Raymond S Douglas
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Shannon S Joseph
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Lisa E Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Dietrich A, Taylor P, White P, Wilson V, Uddin J, Lee RWJ, Dayan C, Jackson S. Establishing the usefulness of the GO-QOL in a UK hospital-treated population with thyroid eye disease in the CIRTED trial. PSYCHOL HEALTH MED 2018; 23:1341-1355. [PMID: 30092670 DOI: 10.1080/13548506.2018.1503693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Thyroid eye disease (TED) is a potentially sight-threatening and cosmetically disfiguring condition arising in 25-50% of patients with Graves' hyperthyroidism. CIRTED is the first study to evaluate the long-term role of radiotherapy and prolonged immunosuppression with azathioprine in treating TED, one aim of which was to validate the use of the English version of GO-QOL in an UK population with TED. In a three stage design over a 48 week period, the GO-QOL was tested and compared to a general measure of quality of life (WHOQOL-Bref). In stage 1 utilising a standard 14 day test-retest design both GO-QOL subscales achieved Cronbach's alphas demonstrating excellent validity and internal reliability (Visual Function 0.929 and 0.931; Appearance 0.888 and 0.906). In stage 2, Repeated Measures ANOVA demonstrated longitudinal validity, with both subscales of the GO-QOL showing significant change over time (Visual Function, η2 = 0.114, p < .001; Appearance, η2 = 0.069, p < .002). In stage 3 the GO-QOL showed discriminant validity at the week 48 time point, with the visual function subscale being able to detect changes in groups identified by clinicians (using BCCOM ratings of improvement or deterioration), while both subscales could detect group differences when based on participants' subjective ratings of TED noticeability and severity. The results of this project provide support for the English translation of the GO-QOL as an outcome measure for patients with moderately severe active Graves' orbitopathy/TED.
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Affiliation(s)
- Alina Dietrich
- a School of Medicine , Cardiff University , Cardiff , UK
| | - Peter Taylor
- b Thyroid Research Group, Systems Immunity Research Institute , Cardiff University School of Medicine , Cardiff , UK
| | - Paul White
- c FET - Engineering, Design & Mathematics , Director Applied Statistics Group, University of the West of England , Bristol , UK
| | - Victoria Wilson
- d Faculty of Health Sciences, Bristol Eye Hospital, University of Bristol , Bristol , UK
| | | | - Richard William John Lee
- f Faculty of Health Sciences , NIHR Moorfields Biomedical Research Centre, University of Bristol , Bristol , UK
| | - Colin Dayan
- a School of Medicine , Cardiff University , Cardiff , UK
| | - Sue Jackson
- g Department of Psychology , Centre for Appearance Research, University of the West of England , Bristol , UK
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Wang CY, Ho RW, Fang PC, Yu HJ, Chien CC, Hsiao CC, Kuo MT. The function and morphology of Meibomian glands in patients with thyroid eye disease: a preliminary study. BMC Ophthalmol 2018; 18:90. [PMID: 29649988 PMCID: PMC5898047 DOI: 10.1186/s12886-018-0763-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 04/03/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To investigate function and morphology of the meibomian gland (MG) in patients with thyroid eye disease (TED). METHODS In this prospective case series study, patients with unilateral or bilateral TED were consecutively enrolled. The diagnosis of TED was based on the typical orbital findings and/or radiographic evidence. The disease activity of TED was classified according to the clinical activity score (CAS). Degrees of lagophthalmos and exophthalmos, blinking rates, and results of the Schirmer test 1 were also recorded. All patients completed the SPEED questionnaire and underwent MG assessment, including lipid layer thickness (LLT), MG dropout (MGd), and MG expression. RESULTS In total 31 eyes from 17 patients with unilateral or bilateral TED were included. Patients were divided into inactive TED (CAS 0-1; 20 eyes from 11 patients) and active TED (CAS 2-3, 11 eyes from 6 patients) groups. MGd was significantly more severe in the active TED than the inactive TED group [Median (Inter-quartile region): 3.0 (2.0-3.0) vs. 2.0 (1.0-2.0) degree, P = 0.04]. However, patients with active TED had thicker LLT than those with inactive TED (90.0 [80.0-100.0] vs. 65.0 [47.8-82.5] nm, P = 0.02), and LLT was positively correlated with lagophthalmos (r = 0.37, P = 0.04). CONCLUSIONS Patients with active TED had more severe MGd, but thicker LLT. Active TED may cause periglandular inflammation of MGs, leading to MGd, but compensatory secretion from residual MGs and lagophthalmos-induced forceful blinking might temporarily release more lipids over the tear film.
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Affiliation(s)
- Chia-Yu Wang
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Ren-Wen Ho
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chiung Fang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hun-Ju Yu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Chih Chien
- Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chang-Chun Hsiao
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
| | - Ming-Tse Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Jellema HM, Saeed P, Mombaerts I, Dolman PJ, Garrity J, Kazim M, Dhrami-Gavazi E, Lyons C, Nieuwkerk P, Mourits MP. Objective and subjective outcomes of strabismus surgery in Graves' orbitopathy: a prospective multicentre study. Acta Ophthalmol 2017; 95:386-391. [PMID: 28133945 DOI: 10.1111/aos.13367] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/18/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the change and interrelationship of the field of binocular single vision (BSV) and the quality of life (QoL), tested with two different tools, after one or two strabismus surgeries in patients with Graves' orbitopathy (GO). METHODS Prospectively, consecutive patients with GO who were scheduled for their first strabismus surgery were recruited from five centres specialized in the treatment of GO. One week preoperatively and 3 months after the last operation, a full ophthalmic and orthoptic examination was performed. Change in field of BSV, GO-QoL and thyroid eye disease-QoL (TED-QoL) was recorded. RESULTS A total of 59 met all the eligibility criteria of whom 15 underwent two strabismus operations. The median (interquartile range) preoperative score of the field of BSV was 0 (0-0), which improved to 73 (53-85) after the correction(s) (p < 0.001). After the first surgery, a significant higher score of the field of BSV was found in the patients who underwent one operation (76; 60-86) compared with those who underwent two 0 (0-63) operations (p < 0.001). After the second surgery, this score increased to 62 (40-76; p = 0.05). A moderate correlation was found between the score of the field of BSV and the GO-QoL visual functioning (VF) questionnaires (r = 0.485; p < 0.001). Both the GO-QoL and TED-QoL for VF and appearance (AP) showed significantly higher scores after the treatment (p < 0.001). CONCLUSION After strabismus surgery in GO patients, both the field of BSV and quality of life questionnaires increase. In approximately 30% of the patients, an additional strabismus surgery is performed. This second surgery significantly expands the field of BSV and the quality of life.
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Affiliation(s)
| | - Peerooz Saeed
- Department of Ophthalmology; University of Amsterdam; Amsterdam The Netherlands
| | - Ilse Mombaerts
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - Peter J. Dolman
- Department of Ophthalmology and Visual Sciences; University of British Columbia; Vancouver British Columbia Canada
| | - Jim Garrity
- Department of Ophthalmology; Mayo Clinic; Rochester New York USA
| | - Mike Kazim
- Department of Ophthalmology; Columbia University; College of Physicians and Surgeons; New York New York USA
| | - Elona Dhrami-Gavazi
- Department of Ophthalmology; Columbia University; College of Physicians and Surgeons; New York New York USA
| | - Christopher Lyons
- Department of Ophthalmology and Visual Sciences; University of British Columbia; Vancouver British Columbia Canada
| | - Pythia Nieuwkerk
- Department of Medical Psychology; University of Amsterdam; Amsterdam The Netherlands
| | - Maarten P. Mourits
- Department of Ophthalmology; University of Amsterdam; Amsterdam The Netherlands
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Davies MJ, Dolman PJ. Levator Muscle Enlargement in Thyroid Eye Disease-Related Upper Eyelid Retraction. Ophthalmic Plast Reconstr Surg 2017; 33:35-39. [DOI: 10.1097/iop.0000000000000633] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Campi I, Vannucchi G, Salvi M. THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves' orbitopathy. Eur J Endocrinol 2016; 175:R117-33. [PMID: 27032693 DOI: 10.1530/eje-15-1164] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/31/2016] [Indexed: 12/22/2022]
Abstract
Management of Graves' orbitopathy (GO) must be based on the correct assessment of activity and severity of the disease. Activity is usually assessed with the Clinical Activity Score, whereas severity is classified according to a European Group On Graves' Orbitopathy (EUGOGO) consensus statement as mild, moderate-to-severe, and sight-threatening. Myopathic and chronic congestive forms are uncommon clinical presentations of GO. Restoration and maintenance of stable euthyroidism are recommended in the presence of GO.In moderate-to-severe disease, steroids have been widely employed and have shown to possess an anti-inflammatory activity, but about 20-30% of patients are not responsive and present recurrence. Some novel immunosuppressors have already been employed in clinical studies and have shown interesting results, although the lack of randomized and controlled trials suggests caution for their use in clinical practice. Potential targets for therapy in GO are the thyroid-stimulating hormone and the insulin-like growth factor 1 receptor on the fibroblasts, inflammatory cytokines, B and T cells, and the PIK3/mTORC1 signaling cascades for adipogenesis. A recent open study has shown that tocilizumab, an anti-sIL-6R antibody, inactivates GO. Consistent reports on the efficacy of rituximab have recently been challenged by randomized controlled trials.As the main goal of treatment is the well-being of the patient, the therapeutic strategy should be addressed to better suit the patient needs, more than improving one or more biological parameters. The increasing availability of new therapies will expand the therapeutic options for GO patients and allow the clinician to really personalize the treatment to better suit the patients' personal needs.
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Affiliation(s)
- Irene Campi
- Graves' Orbitopathy CenterEndocrinology, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Guia Vannucchi
- Graves' Orbitopathy CenterEndocrinology, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Mario Salvi
- Graves' Orbitopathy CenterEndocrinology, Fondazione IRCCS Cà Granda, Milan, Italy
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Iacobæus L, Sahlin S. Evaluation of quality of life in patients with Graves´ ophthalmopathy, before and after orbital decompression. Orbit 2016; 35:121-125. [PMID: 27159575 DOI: 10.1080/01676830.2016.1176049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Graves' ophthalmopathy (GO) is a potentially sight threatening orbital disease that can have a large negative impact on the quality of life of the patient. Studies on long-term effects of GO on the quality of life are few. The aim of this study is to evaluate the health-related quality of life in patients with GO, before and after orbital decompression surgery. This is a prospective, longitudinal, interventional study in which patients who had orbital decompression were given the Graves´ ophthalmopathy quality of life questionnaire (GO-QOL) before and after surgery. The GO-QOL is a disease specific instrument to measure health-related quality of life. The answers are transformed into scores from 0-100 on 2 subscales. Higher score indicates better health. An additional patient satisfaction questionnaire was also given post-surgery. A significant, long-term, improvement in quality of life after orbital decompression was noted (p < 0.001, paired t-test). 50 patients were included and follow-up time was 5.3 ± 1.2 years (mean ± SD). The QOL-scores increased 28 ± 35 and 26 ± 31 points, respectively, on the two subscales, "visual functioning" and "appearance" (mean ± SD). The patient satisfaction questionnaire showed that 88% of the patients would recommend orbital decompression to a fellow patient. Persistent disturbing oscillopsia was seen in 2% and persistent disturbing infraorbital nerve hypoesthesia in 8% of the patients. Orbital decompression surgery has a positive effect on quality of life for patients with severe GO. The GO-QOL questionnaire showed significant improvement in QOL-scores even many years after surgery.
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Affiliation(s)
| | - Sven Sahlin
- b Department of Reconstructive Plastic Surgery , Karolinska University Hospital , Stockholm , Sweden
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Jellema HM, Braaksma-Besselink Y, Limpens J, von Arx G, Wiersinga WM, Mourits MP. Proposal of success criteria for strabismus surgery in patients with Graves' orbitopathy based on a systematic literature review. Acta Ophthalmol 2015; 93:601-9. [PMID: 25876459 DOI: 10.1111/aos.12717] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 02/18/2015] [Indexed: 11/29/2022]
Abstract
Proposal of success criteria for strabismus surgery for patients with Graves' orbitopathy (GO) based on a systematic review of the literature. We performed a systematic search of OVID MEDLINE, OVID Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and the publisher subset of PubMed, to identify studies reporting on success criteria of strabismus surgery in GO. In addition, we handsearched several orthoptic journals and proceedings of strabismological congresses. Of the 789 articles retrieved, 42 articles described success criteria for strabismus surgery in GO. Most studies defined success in terms of a subjective diplopia-free field in primary and down gaze. Almost half of the studies used a graded scale (excellent, good, acceptable and failure) to describe the outcome of surgery. Three of the eligible studies described a tool to quantify the field of single vision in detail. Quality of life was not reported as an outcome measure in any of the published studies. In conclusion, success criteria for strabismus surgery in patients with GO are poorly defined and no consensus is available. The lack of standardization hampers comparative studies and thus the search for the best surgical treatment for diplopia in patients with GO. Therefore, we propose strict success criteria including a tool for quantification of remaining diplopia plus a disease-specific quality of life questionnaire (the GO-QoL).
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Affiliation(s)
| | | | | | - Georg von Arx
- ADMEDICO Augenzentrum; Interdisziplinäres Zentrum für Endokrine Orbitopathie; Olten Switzerland
| | - Wilmar M. Wiersinga
- Department of Endocrinology and Metabolism; Academic Medical Center; Amsterdam The Netherlands
| | - Maarten P. Mourits
- Department of Ophthalmology; Academic Medical Center; Amsterdam The Netherlands
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Al Qahtani ES, Rootman J, Kersey J, Godoy F, Lyons CJ. Clinical Pearls and Management Recommendations for Strabismus due to Thyroid Orbitopathy. Middle East Afr J Ophthalmol 2015; 22:307-11. [PMID: 26180468 PMCID: PMC4502173 DOI: 10.4103/0974-9233.159731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thyroid orbitopathy causes a unique form of strabismus with adult-onset diplopia. Prisms can be a temporizing measure, but many patients require strabismus surgery, which can be challenging. In this article, we highlight clinical guidelines for addressing strabismus due to thyroid orbitopathy and review our surgical experience.
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Affiliation(s)
- Elham S Al Qahtani
- Department of Ophthalmology and Visual Sciences, University of British Columbia and Department of Ophthalmology, BC Children's Hospital, Vancouver, BC, Canada
| | - Jack Rootman
- Department of Ophthalmology and Visual Sciences, University of British Columbia and Department of Ophthalmology, BC Children's Hospital, Vancouver, BC, Canada
| | - James Kersey
- Department of Ophthalmology and Visual Sciences, University of British Columbia and Department of Ophthalmology, BC Children's Hospital, Vancouver, BC, Canada
| | - Flavia Godoy
- Department of Ophthalmology and Visual Sciences, University of British Columbia and Department of Ophthalmology, BC Children's Hospital, Vancouver, BC, Canada
| | - Christopher J Lyons
- Department of Ophthalmology and Visual Sciences, University of British Columbia and Department of Ophthalmology, BC Children's Hospital, Vancouver, BC, Canada
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Xu SH, Li XJ, Chen GF, Zheng QX, Yang Y, Hu YX, Wang K, Liu C. A questionnaire survey on the management of Graves' orbitopathy in China: A comparison with Europe and Latin-America. Chronic Dis Transl Med 2015; 1:117-123. [PMID: 29062996 PMCID: PMC5643564 DOI: 10.1016/j.cdtm.2015.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Management of Graves' orbitopathy (GO) continues to be a challenge to clinical endocrinologists. In the last few years, surveys on GO management have succeeded in elucidating trends in Europe and Latin America. To determine how endocrinologists in China assess and treat patients with GO and gain insight into how to make the management of this disease more uniform and standardized. METHODS Based on the questionnaire used in the European survey on GO, a questionnaire in China was drafted and circulated to the members of Chinese Society of Endocrinology (CSE) during the annual meeting. RESULTS A total of 124 valid responses were analysed. Almost all respondents (94.4%) claimed that a multidisciplinary approach for GO management was valuable. Over 80% of the participants advocated the assessment of exophthalmometry, vision, visual fields by perimetry, eye movements, and fundoscopy. Glucocorticoids were preferred as the first-line therapy by 92.7% of respondents, among them, 59.7% choose the intravenous route. The treatment strategy for GO with intravenous glucocorticoids therapy still remains debatable. Anti-thyroid drugs (ATDs) were the most common choice (72.6%) for first-line therapy of coexisting hyperthyroidism. Treatment options for GO were very similar among Chinese, Latin-American and European respondents, whereas radioactive iodine and surgical treatment were more often indicated for co-existing hyperthyroidism in China. CONCLUSION The appropriate treatment for patients with GO is controversial even among thyroid specialists. Further training of thyroid specialists, easier access of patients to multidisciplinary centres and establishment of practice guidelines are required for the management of this condition in China.
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Affiliation(s)
- Shu-Hang Xu
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
| | - Xing-Jia Li
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
| | - Guo-Fang Chen
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
| | - Quan-Xi Zheng
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
| | - Yu Yang
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
| | - Yong-Xin Hu
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
| | - Kun Wang
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
| | - Chao Liu
- Endocrine and Diabetes Center, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Branch of China Academy of Chinese Medical Science, Nanjing, Jiangsu, 210028, China
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Okosieme OE, Lazarus JH. Important considerations in the management of Graves’ disease in pregnant women. Expert Rev Clin Immunol 2015; 11:947-57. [DOI: 10.1586/1744666x.2015.1054375] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Evaluation of thyroid eye disease: quality-of-life questionnaire (TED-QOL) in Korean patients. Can J Ophthalmol 2014; 49:167-73. [DOI: 10.1016/j.jcjo.2013.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 11/12/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022]
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