Clinical features and clinical course of thyroid-associated ophthalmopathy: a case series of 3620 Chinese cases

Abstract

Objectives To determine the clinical features and course of thyroid-associated ophthalmopathy (TAO) in a large sample of Chinese patients. Design and methods We retrospectively identified a cohort of consecutive patients diagnosed with TAO at the West China Hospital from October 1, 2009 to October 1, 2019. We analysed clinical data from 3620 patients, including demographic data, clinical manifestations, ophthalmology examinations, and prognosis. Results TAO most frequently occurred with hyperthyroidism, with most patients developing TAO after thyroid disease (TD). The TAO phenotype was asymmetric in 375 (50.7%) euthyroid patients, 25 (27.8%) hypothyroid patients, and 314 (12.1%) hyperthyroid patients (p < 0.0001). The most frequent symptom was lid lag and the most commonly involved extraocular muscle was the inferior rectus. Severity assessment (NOSPECS score) and clinical activity assessment (Clinical Activity Scores, CAS) differed significantly between male and female patients (P < 0.000). The majority (88.8%) of patients had clinically inactive TAO, and only 3.2% of cases were sight-threatening. Regarding the clinical process, 75.5% of patients had an active phase time less than 12 months and 2.1% showed complete remission. Conclusions TAO most commonly develops in females and is closely related to hyperthyroidism. Euthyroid TAO often has an asymmetric clinical phenotype. CAS combined with magnetic resonance imaging can improve the detection of TAO. NOSPECS scores should be slightly refined regarding the criteria for corneal involvement. Clinical management of TAO should be individualized according to CAS or NOSPECS assessments and a multidisciplinary approach is paramount. A minority of patients showed complete remission.

Local-to-Remote Brain Functional Connectivity in Patients with Thyroid-Associated Ophthalmopathy and Assessment of Its Predictive Value Using Machine Learning

“… 41 In recent years, clinical observational studies have reported that TAO was involved in functional and psychological alterations in the brain (eg, depression, memory impairment, emotional instability and personality irregularities). 42 , 43 Another neuroimaging research indicated that subjects with major depression had elevated FC between the left Hipp and left MOG, which may reflect memory deficits and sleep disorders in these patients. 27 Consistent with these studies, our current research found that, in comparison with HCs, TAO patients displayed higher ReHo values in the left Hipp, and decreased FC between the left and right Hipp.…”

Diffusion Tensor Imaging Technology to Quantitatively Assess Abnormal Changes in Patients With Thyroid-Associated Ophthalmopathy

“…The clinical features included age, gender, clinical activity score (CAS) and European Group on Graves' Orbitopathy (EUGOGO) classification. The CAS is used to evaluate the patient's disease activity, so as to determine the patient's sensitivity to hormone therapy (Du et al, 2021). The CAS includes 7 points, one point for each item; a patient with a CAS ≥ 3 is considered in the active phase, and a patient with a…”

A clinical study of topical treatment for thyroid-associated ophthalmopathy with dry eye syndrome

“…Therefore, in this study, mild or moderate-to-severe inactive TAO patients were selected as the research subjects. Rebecca et al noted that the condition has an annual adjusted incidence rate of 16 women and 3 men per 100,000 individuals, while in the study by Du et al, the female-to-male ratio was 1.83:1 [28,29] . In the current study, the female-to-male ratio was about 1:3.64.…”