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Yu X, Chen M, Wu J, Song R. Research progress of SIRTs activator resveratrol and its derivatives in autoimmune diseases. Front Immunol 2024; 15:1390907. [PMID: 38962006 PMCID: PMC11219927 DOI: 10.3389/fimmu.2024.1390907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/06/2024] [Indexed: 07/05/2024] Open
Abstract
Autoimmune diseases (AID) have emerged as prominent contributors to disability and mortality worldwide, characterized by intricate pathogenic mechanisms involving genetic, environmental, and autoimmune factors. In response to this challenge, a growing body of research in recent years has delved into genetic modifications, yielding valuable insights into AID prevention and treatment. Sirtuins (SIRTs) constitute a class of NAD-dependent histone deacetylases that orchestrate deacetylation processes, wielding significant regulatory influence over cellular metabolism, oxidative stress, immune response, apoptosis, and aging through epigenetic modifications. Resveratrol, the pioneering activator of the SIRTs family, and its derivatives have captured global scholarly interest. In the context of AID, these compounds hold promise for therapeutic intervention by modulating the SIRTs pathway, impacting immune cell functionality, suppressing the release of inflammatory mediators, and mitigating tissue damage. This review endeavors to explore the potential of resveratrol and its derivatives in AID treatment, elucidating their mechanisms of action and providing a comprehensive analysis of current research advancements and obstacles. Through a thorough examination of existing literature, our objective is to advocate for the utilization of resveratrol and its derivatives in AID treatment while offering crucial insights for the formulation of innovative therapeutic approaches.
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Affiliation(s)
- Xiaolong Yu
- Jiangsu Key Laboratory of Immunity and Metabolism, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Mingkai Chen
- Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Jiabiao Wu
- Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Ruixiao Song
- Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
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Schuh A, Bayerl-Löhe K, Hintschich C. Observation of Unexplained Cases of Unilateral Upper Eyelid Retraction from Idiopathic Inflammation or an Atypical Form of Graves' Orbitopathy. Klin Monbl Augenheilkd 2024. [PMID: 38802076 DOI: 10.1055/a-2307-0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND We observed cases of unilateral upper eyelid retraction (UER) with unclear pathogenesis, where a definitive diagnosis of Graves' orbitopathy (GO) could not be made and other pathologies were ruled out. The aim is to present patients' findings, discuss possible underlying mechanisms, and to describe diagnostic testing and therapeutic approaches. PATIENTS AND METHODS Patients were retrospectively analyzed who presented to the Department of Ophthalmology of LMU Munich between 2016 and 2021 without a definitive diagnosis of GO or other pathological causes. RESULTS Thirteen patients with unexplained UER were included; all showed thickening of the levator complex in imaging. When biopsy was performed, no malignancy could be detected. Therapeutic strategies included oral steroids and surgical upper eyelid blepharotomy. CONCLUSION As regards to pathogenesis, in 7/13 patients, a condition of idiopathic UER due to an idiopathic inflammatory response can be postulated rather than a variant of GO.
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Affiliation(s)
- Anna Schuh
- Department of Ophthalmolgy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Katharina Bayerl-Löhe
- Department of Ophthalmolgy, Ludwig-Maximilians-University Munich, Munich, Germany
- Augenzentrum auf der Insel, Ingolstadt, Germany
| | - Christoph Hintschich
- Department of Ophthalmolgy, Ludwig-Maximilians-University Munich, Munich, Germany
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Koizumi T, Tanaka T, Umeda K, Komiyama D, Obata H. Correlation between extraocular muscle enlargement and thyroid autoantibodies in thyroid eye disease. Jpn J Ophthalmol 2024; 68:250-258. [PMID: 38609717 PMCID: PMC11087308 DOI: 10.1007/s10384-024-01061-7] [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: 08/22/2023] [Accepted: 01/31/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE This study aimed to investigate the factors affecting extraocular muscle enlargement in thyroid eye disease (TED). STUDY DESIGN Retrospective study. METHODS The thyroid-stimulating hormone (TSH) receptor antibody (TRAb), thyroid-stimulating antibody (TSAb), antithyroid peroxidase antibody (ATPO), and antithyroglobulin antibody (ATG) levels in patients diagnosed with TED who underwent orbital magnetic resonance imaging were assessed. The control group comprised the contralateral eye of patients who underwent orbital magnetic resonance imaging (MRI) for unilateral eyelid tumors or orbital disease. The thickness of the bilateral rectus muscles and superior oblique muscles was measured on orbital MRI. Muscle enlargement was classified as unilateral/bilateral and symmetric/asymmetric. The effects of age, sex, smoking history, TSH, thyroid hormone, and thyroid autoantibodies on the muscle thickness and number of enlarged muscles were assessed by use of simple and multiple regression analyses. RESULTS The TED and control groups comprised 41 and 44 cases, respectively. The positivity rate of TSAb in patients with TED was 92.7% higher than that of the other autoantibodies. Muscle enlargement was observed in 29 of the 41 cases (70.7%). Older age and higher TSAb levels were identified as significant factors affecting the total muscle thickness and number of enlarged muscles. Bilateral muscle enlargement and asymmetrical muscle enlargement were observed in 17 (58.6%) and 23 (79.3%) of the 29 cases, respectively. The TSAb levels and age had no significant effect on the type of muscle enlargement. CONCLUSIONS TSAb showed significant associations with extraocular muscle enlargement. Measurement of TSAb, rather than of TRAb, may be more useful for diagnosing extraocular muscle enlargement in patients with TED.
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Affiliation(s)
- Takahiro Koizumi
- Department of Ophthalmology, Saitama Medical Center, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Takahiro Tanaka
- Department of Ophthalmology, Saitama Medical Center, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Kazuki Umeda
- Department of Ophthalmology, Saitama Medical Center, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Daisuke Komiyama
- Department of Ophthalmology, Saitama Medical Center, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Hiroto Obata
- Department of Ophthalmology, Saitama Medical Center, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
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Rana K, Garg D, Yong LSS, Leyden J, Patel S, Slattery J, Davis G, Chan WO, Selva D. Asymmetric proptosis in thyroid eye disease. Int Ophthalmol 2024; 44:206. [PMID: 38678129 PMCID: PMC11055760 DOI: 10.1007/s10792-024-03141-6] [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: 12/11/2023] [Accepted: 04/11/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Patients with thyroid eye disease (TED) can present with asymmetric disease. The purpose of this study was to evaluate the prevalence of asymmetric TED in an Australian cohort and investigate clinical, biochemical, and radiological associations of asymmetric TED. METHODS This was a retrospective study of patients with TED who underwent Hertel exophthalmometry and orbital computed tomography (CT) scans. Asymmetry was defined as a difference in the globe protrusion of ≥ 3 mm using Hertel exophthalmometry. Data was collected on patient demographics, clinical disease presentation, thyroid function tests and antibody levels. Muscles volumes were determined by manually segmenting the extraocular muscles on CT scans using a commercially available software. RESULTS 172 orbits from 86 patients were included in the study. 28 (33%) patients had asymmetric TED. No significant differences were observed in age, gender, thyroid hormone status, anti-thyroid peroxidase levels, thyroid stimulating hormone receptor antibodies, disease activity status, or dysthyroid optic neuropathy between the asymmetric and non-asymmetric groups. The extraocular muscle volumes were significantly higher in the asymmetric orbit compared to its contralateral orbit. CONCLUSION Asymmetric TED is a reasonably common occurrence in the course of TED. It is associated with higher extraocular muscle volumes, suggesting muscle enlargement as one of the underlying contributors to asymmetric proptosis. Thyroid eye disease should be considered in the differential of asymmetric orbital inflammatory disease.
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Affiliation(s)
- Khizar Rana
- Department of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia.
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
| | - Devanshu Garg
- Department of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Lee Shien S Yong
- Department of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - James Leyden
- Department of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Sandy Patel
- Department of Medical Imaging, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - James Slattery
- Department of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Garry Davis
- Department of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Weng Onn Chan
- Department of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Dinesh Selva
- Department of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
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Jang HJ, Jo HY. Orbital apex syndrome in pediatric thyroid eye disease: a case report and literature review. Ann Pediatr Endocrinol Metab 2024; 29:138-140. [PMID: 38291758 PMCID: PMC11076231 DOI: 10.6065/apem.2346118.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Hyun ji Jang
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Ha young Jo
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
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Li Z, Luo Y, Feng X, Zhang Q, Zhong Q, Weng C, Chen Z, Shen J. Application of Multiparameter Quantitative Magnetic Resonance Imaging in the Evaluation of Graves' Ophthalmopathy. J Magn Reson Imaging 2023; 58:1279-1289. [PMID: 36780178 DOI: 10.1002/jmri.28642] [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: 11/04/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Assessment of the activity of Graves' ophthalmopathy (GO) is difficult. Existing methods need improvement. PURPOSE Investigate the application of multiparametric magnetic resonance imaging (MRI) in GO. STUDY TYPE Retrospective. POPULATION A total of 235 GO patients (age: 38.8 ± 13.4 years; 90 male; 96 active patients). FIELD STRENGTH/SEQUENCE Short-tau inversion recovery (STIR) fast spin echo, multiecho spin echo T2 mapping and 3D T1-weighted fast field echo sequences at 3.0 T. ASSESSMENT Two physicians assessed the mean and maximum signal intensity ratio of extraocular muscles to white matter (SIR), T2 relaxation time (T2RT), extraocular muscle area (EMA), fat fraction (FF), retrobulbar fat volume (RFV), and extraocular muscle volume (EMV). Clinical activity score (CAS) ≧ 3 was in active stage. STATISTICAL TESTS The optimal cut-off point of diagnostic efficacy was selected using receiver operating characteristic (ROC) curve analysis and evaluated using area under the curve (AUC), compared using Student's t test, analysis of variance or Kruskal-Wallis H test. The correlation used Pearson correlation analysis. The discriminant equation used a binary logistic regression analysis. P < 0.05 was considered statistically significant. RESULTS The SIRmean, SIRmax, T2RTmean, T2RTmax, EMA, and EMV in active GO patients were significantly higher than those in inactive and were positively correlated with CAS (r = 0.276, 0.228, 0.438, 0.388, 0.502, and 0333, respectively). The FFmax of active patients was significantly lower than that of inactive patients and was negatively correlated with CAS (r = -0.44). Logistic regression analysis indicated that T2RTmean was independently associated with GO active periods and had good diagnostic performance (area under ROC curve = 0.736, sensitivity 70.7%, specificity 69.3%). T2RTmean ≧ 74.295 could be a diagnostic cut-off for judging GO activity (sensitivity 55.3%). CONCLUSION SIR, T2RT, EMV, and FF can quantitatively assess the activity and severity of GO and can potentially provide a basis for clinical judgment and selection of treatment options. EVIDENCE LEVEL 4. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Zhangfang Li
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yaosheng Luo
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China
| | - Xiaoting Feng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qing Zhang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qiang Zhong
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Chanyan Weng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhi Chen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Jie Shen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China
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Eshraghi B, Pourazizi M, Abbasi M, Mohammadbeigy I. A comparison between bilateral and unilateral thyroid eye disease. Int Ophthalmol 2023; 43:2957-2962. [PMID: 37067696 DOI: 10.1007/s10792-023-02702-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/05/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE To compare characteristics of unilateral vs. bilateral thyroid eye disease (TED). METHODS This retrospective analytical cross-sectional study was conducted on patients with TED who were evaluated at an academic referral center over a 6-year period. We compared demographics, activity (clinical activity score) and severity (EUGOGO classification) of TED, thyroid disease duration, TED duration, the time interval between thyroid and eye involvement, thyroid function status, and clinical signs between bilateral and unilateral TED. RESULTS Three hundred eighty-three patients including 213 females (55.6%), who had a mean age of 40.23 ± 13.72 years, were enrolled. Active TED was seen in 8.8% of bilateral and none of unilateral cases (P = 0.04). Bilateral TED patients had more severe disease (P = 0.001). The distribution of hyperthyroidism, hypothyroidism, and euthyroidism was significantly different between unilateral and bilateral groups (P = 0.001). Abnormal ocular motility was present in 26.3% versus 2.3% of bilateral and unilateral ones, respectively (P = 0.001). Proptosis was more prevalent in bilateral than unilateral cases (P = 0.001). We did not observe any statistically significant difference between the two groups in others variables. CONCLUSION Bilateral TED patients present with more severity, activity, movement abnormality, proptosis, and hyperthyroidism.
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Affiliation(s)
- Bahram Eshraghi
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Pourazizi
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Abbasi
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iman Mohammadbeigy
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Bhattarai HB, Thapaliya I, Dhungana S, Singh PB, Bhattarai M, Pokhrel B, Khanal S, Lamichhane S, Gautam S, Basnet B. Unilateral proptosis in a patient with thyroid eye disease: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231190669. [PMID: 37533488 PMCID: PMC10392154 DOI: 10.1177/2050313x231190669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023] Open
Abstract
Unilateral proptosis is an abnormality in which one eye sticks out forward more than the other. Bulging of the eye is commonly seen in Graves' ophthalmopathy, but it's mostly bilateral. Thyroid eye disease presents as the most common extrathyroidal manifestation of Graves' disease, and rarely leads to unilateral proptosis. A 25-year-old female with a history of weight loss, menstrual irregularities, and palpitations presented with progressive right eye bulging, which was further confirmed by magnetic resonance imaging and biochemical investigations. Magnetic resonance imaging of the orbit revealed unilateral extraocular muscle enlargement and enhancement with sparing of the tendons. Timely therapy is crucial for reversing the ocular manifestations of thyroid eye disease.
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Affiliation(s)
| | | | | | | | | | - Bidushi Pokhrel
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Santosh Khanal
- Tribhuvan University, Institute of Medicine, Maharajgunj, Nepal
| | - Saral Lamichhane
- Gandaki Medical College, Teaching Hospital and Research Center, Pokhara, Nepal
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Yang M, Wang Y, Du B, He W. Clinical phenotypes of euthyroid, hyperthyroid, and hypothyroid thyroid-associated ophthalmopathy. Graefes Arch Clin Exp Ophthalmol 2023:10.1007/s00417-023-05998-2. [PMID: 36806995 DOI: 10.1007/s00417-023-05998-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/14/2023] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To compare the demographic and clinical phenotypes of thyroid-associated ophthalmopathy (TAO) with euthyroidism (Eu-TAO), hyperthyroidism (Hr-TAO), and hypothyroidism (Ho-TAO). METHODS We enrolled 2158 TAO patients in this retrospective study and assessed their demographics, clinical manifestations, activity, and severity. RESULTS Among the enrolled patients, 526 (24.37%) had Eu-TAO, 1544 (71.55%) had Hr-TAO, and 88 (4.08%) had Ho-TAO. Compared to Hr-TAO (2.02) and Ho-TAO (2.52) patients, Eu-TAO (1.57) patients had the lowest female-to-male ratio (p = 0.026). The mean ages of Eu-TAO, Hr-TAO, and Ho-TAO patients were 43.11 ± 12.05, 42.23 ± 13.63, and 47.39 ± 13.28 years, respectively (p = 0.001). Patients with Eu-TAO had more unilateral involvement (50% vs. 14.38% vs. 21.59%, p < 0.001) than Hr-TAO or Ho-TAO patients. Clinically active TAO patients presented 8.56% in euthyroid vs. 13.86% in hyperthyroid vs. 11.36% in hypothyroid (p = 0.006). Regarding the severity of the European Group on Graves' Orbitopathy (EUGOGO) classification among euthyroid, hyperthyroid, and hypothyroid patients, mild TAO was present in 67.68, 54.27, and 72.72% of participants, moderate-to-severe TAO in 31.18, 42.49, and 26.14%, and sight-threatening TAO in 1.14, 3.24, and 1.14%, respectively. Eu-TAO was positively correlated with unilateral involvement (OR = 5.671, p < 0.001) and age (OR = 1.013, p = 0.003) and negatively correlated with the female-to-male ratio (OR = 0.656, p < 0.001) and TAO severity (OR = 0.742, p < 0.01). CONCLUSIONS Eu-TAO patients are older and less likely to be female, and show more unilateral and milder clinical phenotypes than hyper/hypothyroid TAO patients.
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Affiliation(s)
- Mei Yang
- Department of Ophthalmology, West China School of Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Yujiao Wang
- Department of Ophthalmology, West China School of Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Baixue Du
- Department of Ophthalmology, West China School of Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Weimin He
- Department of Ophthalmology, West China School of Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District, Chengdu, 610041, Sichuan Province, China.
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Ali M, Abouzaid M, Clarke L, Lau G, Mitchell A, Napier C, Pearce S. A rare case of severe bilateral Graves' orbitopathy involving an anophthalmic socket. Endocrinol Diabetes Metab Case Rep 2023; 2023:22-0341. [PMID: 36625261 PMCID: PMC9875024 DOI: 10.1530/edm-22-0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Summary This is a report of a rare case of Graves' hyperthyroidism associated with severe bilateral Graves' orbitopathy, in a patient with an anophthalmic eye socket. On clinical review her prosthetic eye (left eye) was tilting upwards, along with worsening of Graves' orbitopathy (GO) in the only seeing eye. As she refused IV glucocorticoids, she was offered rituximab which only caused a transient improvement in the clinical activity score of the eye. She had persistent right upper lid retraction of 6 mm, associated with lagophthalmos. To protect her seeing eye from corneal ulceration, the patient received a botulinum toxin injection to the right upper eyelid to induce blepharoptosis as an interim measure prior to right upper eyelid blepharotomy in April 2021. This patient remains biochemically euthyroid on block and replace therapy and her TRAb level is falling over time. Treatment for active GO is ongoing and the patient required a redo blepharotomy for painful corneal exposure in the right eye. Learning points Graves' orbitopathy (GO) does not actually primarily affect the eyeball itself but the orbital contents as well. Patients with severe GO in an only seeing-eyed patient should be referred early to a multidisciplinary Joint Thyroid Eye clinic for expert review and management. Patient outcomes including sight loss are likely to be improved by the extended range of medical and surgical treatment modalities available at specialist clinics treating GO, including the use of immunomodulatory drugs like rituximab or teprotumumab.
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Affiliation(s)
- Mudassir Ali
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Mona Abouzaid
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Lucy Clarke
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Gordon Lau
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Anna Mitchell
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Catherine Napier
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Simon Pearce
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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Tran AQ, Zhou HW, Nanda T, Godfrey KJ, Tooley AA, North VS, Kazim M. Evolution of asymmetric proptosis during the active phase of thyroid eye disease. Orbit 2022; 42:251-255. [PMID: 35801656 DOI: 10.1080/01676830.2022.2088807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To assess the evolution of proptosis asymmetry during the active phase of bilateral thyroid eye disease (TED). METHODS A retrospective study was conducted on patients with bilateral, active TED. Patients were measured by a single observer, using Hertel exophthalmometry from the time of initial presentation, during the active phase of TED, to the stable phase, 24-months later. Asymmetric proptosis was defined as a >2 mm intra-orbital difference in Hertel measurements. RESULTS Fifty-one patients were enrolled. Patients presented at a mean time of 1.1 ± 2.9 months following the onset of TED symptoms. Stability of TED was established at 15.7 ± 12.3 months. At initial presentation, 41% of patients demonstrated asymmetric proptosis. Upon reaching the stable phase, asymmetric proptosis persisted in only 22% of patients. A decline in the rate asymmetric proptosis was greatest within the first 3 months of the active phase. CONCLUSIONS Asymmetric proptosis is common in the setting of early active TED and decreases by 50% when the stable phase is reached. Therefore, diagnostic imaging is not routinely required to exclude alternative pathology in the cases of asymmetric TED. Perhaps more importantly, this finding supports the surgical paradigm of stable phase, graded orbital decompression, performed when the ultimate globe positions are achieved to avoid late postoperative asymmetry, resulting from the unanticipated evolution of proptosis when surgery is performed during the active phase of TED.
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Affiliation(s)
- Ann Q Tran
- Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian HospitalOculoplastic and Orbital Surgery, Edward S. , New York, New York, USA.,Department of Ophthalmology, University of Illinois Eye and Ear Infirmary, Chicago, Illinois, USA
| | - Henry W Zhou
- Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian HospitalOculoplastic and Orbital Surgery, Edward S. , New York, New York, USA
| | - Tavish Nanda
- Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian HospitalOculoplastic and Orbital Surgery, Edward S. , New York, New York, USA
| | - Kyle J Godfrey
- Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian HospitalOculoplastic and Orbital Surgery, Edward S. , New York, New York, USA.,Department of Ophthalmology and Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Andrea A Tooley
- Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian HospitalOculoplastic and Orbital Surgery, Edward S. , New York, New York, USA.,Department of Ophthalmology, Mayo University, Rochester, Minnesota, USA
| | - Victoria S North
- Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian HospitalOculoplastic and Orbital Surgery, Edward S. , New York, New York, USA
| | - Michael Kazim
- Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian HospitalOculoplastic and Orbital Surgery, Edward S. , New York, New York, USA
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Hierl KV, Krause M, Kruber D, Sterker I. 3-D cephalometry of the the orbit regarding endocrine orbitopathy, exophthalmos, and sex. PLoS One 2022; 17:e0265324. [PMID: 35275980 PMCID: PMC8916626 DOI: 10.1371/journal.pone.0265324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/01/2022] [Indexed: 01/04/2023] Open
Abstract
Purpose This study aimed at evaluating the orbital anatomy of patients concerning the relevance of orbital anatomy in the etiology of EO (endocrine orbitopathy) and exophthalmos utilizing a novel approach regarding three-dimensional measurements. Furthermore, sexual dimorphism in orbital anatomy was analyzed. Methods Orbital anatomy of 123 Caucasian patients (52 with EO, 71 without EO) was examined using computed tomographic data and FAT software for 3-D cephalometry. Using 56 anatomical landmarks, 20 angles and 155 distances were measured. MEDAS software was used for performing connected and unconnected t-tests and Spearman´s rank correlation test to evaluate interrelations and differences. Results Orbital anatomy was highly symmetrical with a mean side difference of 0.3 mm for distances and 0.6° for angles. There was a small albeit statistically significant difference in 13 out of 155 distances in women and 1 in men concerning patients with and without EO. Two out of 12 angles showed a statistically significant difference between female patients with and without EO. Regarding sex, statistically significant differences occurred in 39 distances, orbit volume, orbit surface, and 2 angles. On average, measurements were larger in men. Concerning globe position within the orbit, larger distances to the orbital apex correlated with larger orbital dimensions whereas the sagittal position of the orbital rim defined Hertel values. Conclusion In this study, little difference in orbital anatomy between patients with and without EO was found. Concerning sex, orbital anatomy differed significantly with men presenting larger orbital dimensions. Regarding clinically measured exophthalmos, orbital aperture anatomy is an important factor which has to be considered in distinguishing between true exophthalmos with a larger distance between globe and orbital apex and pseudoexophthalmos were only the orbital rim is retruded. Thus, orbital anatomy may influence therapy regarding timing and surgical procedures as it affects exophthalmos.
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Affiliation(s)
| | - Matthias Krause
- Department of Oral & Maxillofacial Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Daniel Kruber
- Department of Informatics and Media, Leipzig University of Applied Sciences, Leipzig, Germany
| | - Ina Sterker
- Department of Ophthalmology, Leipzig University, Leipzig, Germany
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Das L, Singh U, Malhotra B, Bhadada SK, Rastogi P, Singh P, Dutta P, Tadepalli S. Thyroid eye disease with concurrent orbital lymphoma: a radiological surprise. Endocrinol Diabetes Metab Case Rep 2022; 2022:21-0109. [PMID: 35332876 PMCID: PMC9002204 DOI: 10.1530/edm-21-0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/08/2022] [Indexed: 12/04/2022] Open
Abstract
Summary Thyroid eye disease (TED) is the most common extra-thyroidal manifestation in Graves' disease (GD). Additional/concurrent/synchronous pathologies may be present, especially in elderly patients who present with atypical features such as non-axial (or eccentric) proptosis, absence of lid lag and restricted superior extra-ocular movements. A 70-year-old female presented with progressive proptosis of her left eye and diplopia. She was diagnosed with GD a year prior and initiated on carbimazole. On examination, she had eccentric proptosis, restricted superior extra-ocular movements and a palpable mass in the supero-temporal quadrant of the left eye. Her T3 (1.33 ng/mL) and T4 (8.85 µg/dL) were normal with carbimazole. Thyroid-stimulating hormone (TSH)-receptor antibody was positive (3.15 IU/L, reference range <1.75). MRI revealed an enhancing lesion infiltrating the left superior rectus, with concurrent characteristic muscle belly involvement bilaterally. Orbital biopsy showed atypical lymphoid cells (CD20+), suggesting marginal zone lymphoma. CT thorax and abdomen, fluorodeoxyglucose-positron emission tomography and bone marrow examination were normal. The patient was administered orbital radiotherapy for her localised lymphoma and carbimazole was continued. TED is the most common cause of orbital involvement overall and in GD. However, additional or alternative pathology may be present which requires evaluation. MRI can be a useful adjunct in these patients. Orbital lymphoma needs to be staged with workup for disseminated disease. Radiotherapy is the treatment of choice for localized disease. The index case provides evidence for synchronous presentation of dual pathology and highlights the importance of astute clinical examination as well as keeps a low threshold for MRI in selected cases. Learning points Thyroid eye disease can co-exist with other ocular pathology, especially in elderly individuals. Eccentric proptosis, absent lid lag and restriction of eye movements (suggesting tendon involvement) should alert towards the presence of alternative pathology. Orbital imaging using MRI not only has greater sensitivity in diagnosing radiologically bilateral disease in patients who have unilateral involvement clinically but is also useful to identify concurrent neoplasms.
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Affiliation(s)
- Liza Das
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Usha Singh
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bhanu Malhotra
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pulkit Rastogi
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Paramjeet Singh
- Department of Radiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sameeksha Tadepalli
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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