Assessment of disease activity of Graves’ ophthalmopathy

Prummel, Mark F.; Wiersinga, Wilmar M.; Mourits, Maarten P.

doi:10.1007/978-1-4615-4647-4_4

Cited by 13 publications

(17 citation statements)

References 67 publications

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“…Increased reflectivity was thus reported as a general echographic sign in endocrine eye muscle involvement (Ossoinig 1984; Hasenfratz 1987; Given‐Wilson et al 1989) and apparently also comprised early disease, although this was not specified. Recently, Prummel et al (2000) have modified their earlier views (Prummel et al 1993), due to subsequent ‘disappointing experiences’ with ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonically measured horizontal eye muscle thickness in thyroid associated orbitopathy: cross‐sectional and longitudinal aspects in a Danish series

Fledelius

Zimmermann-Belsing

Feldt‐Rasmussen

2003

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: To analyse horizontal extraocular muscle findings by ultrasound and exophthalmometry in a tertiary endocrinology centre series of patients with thyroid associated orbitopathy (TAO). Methods: The 90 thyroid patients included underwent ultrasonic measurement of horizontal eye muscle thickness by a B-scan based technique carried out in addition to their general ophthalmic evaluation. As an indicator of mainly advanced TAO, longterm prednisone or cyclosporine A was given to many of the patients, and drug-resistant visual loss indicated decompression surgery in four of the 90 patients. Thirty-four patients underwent repeated muscle recordings over 15±49 months; this allowed for cross-sectional analysis and the outlining of longitudinal trends. Results and Conclusions: (A) Although marginally overlapping, all four muscle groups were significantly thicker in the study group than in normal control subjects. The mean of the sum of all four muscles was 16.8 mm (range 13.6±21.7 mm) in the control group versus 22.6 mm (range 15.5±36.4 mm) in the thyroid group. (B) Using the clinical NOSPECS grading, more advanced eye involvement was found to generally result in a higher exophthalmometric measurement of protrusion and eye muscle thickness. However, slender rectus muscles and/or normal exophthalmometric values might occur even in advanced orbitopathy. (C) Over a period of 2±4 years, only a few of 34 patients with satisfactory serial ultrasonic measurements returned to their premorbid ophthalmic status. Typically, the extraocular muscles kept their abnormal size after having become clinically quiescent (fibrotic). (D) We found no safe indication regarding disease stage, active or late, from the ultrasonic appearance of the muscle tissue. (E) Discrepancies between various normative eye muscle studies are discussed with regard to computer tomography and magnetic resonance imaging.

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Section: Discussionmentioning

confidence: 99%

Ultrasonically measured horizontal eye muscle thickness in thyroid associated orbitopathy: cross‐sectional and longitudinal aspects in a Danish series

Fledelius

Zimmermann-Belsing

Feldt‐Rasmussen

2003

Acta Ophthalmologica Scandinavica

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“…The muscle showing the lowest reflectivity (in %) was used in the analysis 7 . The T2 relaxation times on MRI were measured as described earlier 20 and the muscle with the lowest T2 time (in ms) was used in the analysis 8 . The uptake at 4 h after injection of 111 indium‐diethylenetriaminepentaacetic acid (DTPA)‐octreotide was measured quantitatively as the mean of eight orbital single photon emission computed tomography (SPECT) scan images and expressed as a ratio vs. the uptake in a temporal area 31 .…”

Section: Methodsmentioning

confidence: 99%

Measuring disease activity to predict therapeutic outcome in Graves’ ophthalmopathy

Terwee¹,

Prummel

Gerding

et al. 2005

Clinical Endocrinology

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SummaryObjective The concept of disease activity in Graves' ophthalmopathy (GO) might explain why as many as one-third of patients do not respond to immunosuppressive treatment, because only patients in the active stage of disease are expected to respond. The hypothesis was adopted that a parameter used to measure disease activity should be able to predict a response to immunosuppressive treatment. The aim of this study was to develop a multivariate prediction model in which all previous tested activity parameters are integrated. Design and PatientsWe included 66 consecutive patients with untreated moderately severe GO who had been euthyroid for at least 2 months. All patients were treated with radiotherapy. Measurements Treatment efficacy after 6 months follow-up was used as the primary outcome measure. Disease severity and 15 different disease activity parameters were assessed before treatment. Univariate and multivariate logistic regression models were used to predict response (model 1) or no change (model 2). Results In multivariate analyses, we found that duration of GO, soft tissue involvement, elevation, soluble interleukin-2 receptor (sIL-2R), soluble CD30 (sCD30), eye muscle reflectivity and octreotide uptake ratio were significant predictors of a response to radiotherapy. Gender, duration of GO, soft tissue involvement, eye muscle reflectivity, IL-6 and urinary glycosaminoglycan (GAG) excretion were significant predictors of no change upon radiotherapy. Prognostic score charts were developed for use in clinical practice to calculate the probability of response (model 1) and the probability of no change (model 2) for each new patient. Finally we used a combination of both models to define a recommended treatment modality for each individual patient, based on both the predicted probabilities of response and no change. We were able to identify the correct treatment (based on a comparison with the observed response) in 89% of the patients. Conclusions Although we strongly recommend that our results should be confirmed in other studies, our findings are the first evidence for the idea that disease (in)activity should determine which kind of treatment should be used.

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“…The CAS consists of seven items and one point is added for each item present: spontaneous pain behind the globe, pain on attempted upgaze, redness of the conjuctiva, redness of the eyelid, chemosis, swelling of the caruncle, and eye lid swelling. For this, physicians could also use local imaging techniques such as the T2 relaxation time on MRI, or the orbital octreotide uptake on scintigraphy (11,12).…”

Section: Assessment Of Disease Activitymentioning

confidence: 99%

Multi-center study on the characteristics and treatment strategies of patients with Graves' orbitopathy: the first European Group on Graves' Orbitopathy experience

Prummel¹,

Bakker²,

Wiersinga³

et al. 2003

Eur J Endocrinol

185

121

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To improve management of patients with Graves' orbitopathy, a multi-center collaborative approach is necessary in order to have large enough sample sizes for meaningful randomized clinical trials. This is hampered by a lack of consensus on how to investigate the eye condition. The European Group on Graves' Orbitopathy aims to overcome this and has designed a preliminary case record form (CRF) to assess Graves' orbitopathy patients. This form was used in this first multi-center study. Aim: To investigate patient characteristics and treatment strategies in 152 new consecutively referred patients with thyroid eye disease seen in nine large European referral centers. Methods: Newly referred patients with Graves' orbitopathy were included who were seen between September and December 2000. Demographic data and a complete ophthalmological assessment were recorded. Results: One-hundred and fifty-two patients (77% females) were included. Diabetes was present in 9%, and glaucoma or cataract in 14% of patients. Forty percent were current smokers, 9% also had dermopathy, and only 33% reported a positive family history of thyroid disease. Mild eye disease was seen in 40%, moderately severe eye disease was seen in 33% and severe eye disease was seen in 28% of patients. Soft tissue involvement was the most frequent abnormality (seen in 75%), proptosis $ 21 mm was found in 63%, eye motility dysfunction in 49%, keratopathy in 16% and optic nerve involvement was found in 21% of patients. According to the clinical impression, 60% had active eye disease. Immunosuppressive treatment was planned more frequently in active patients (57/86; 66%) than in inactive patients (5/57, 9%; Chi-square 46.16; P , 0:02). There were no important differences among the eight centers regarding the severity and the activity of their patients. Conclusions: In view of the large number of patients recruited in only 4 months, multi-center studies in the eight EUGOGO centers appear to be feasible.

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Assessment of disease activity of Graves’ ophthalmopathy

Cited by 13 publications

References 67 publications

Ultrasonically measured horizontal eye muscle thickness in thyroid associated orbitopathy: cross‐sectional and longitudinal aspects in a Danish series

Ultrasonically measured horizontal eye muscle thickness in thyroid associated orbitopathy: cross‐sectional and longitudinal aspects in a Danish series

Measuring disease activity to predict therapeutic outcome in Graves’ ophthalmopathy

Multi-center study on the characteristics and treatment strategies of patients with Graves' orbitopathy: the first European Group on Graves' Orbitopathy experience

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