Clinical Presentation and Natural History of Graves’ Ophthalmopathy

Perros, Petros; Dickinson, A J; Kendall‐Taylor, P.

doi:10.1007/978-1-4615-1447-3_8

Cited by 5 publications

(6 citation statements)

References 49 publications

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“…In the present case, the eye signs did not improve in spite of euthyroid state and there was concern about worsening superficial keratitis; consequently, methylprednisolone pulse therapy was administered. Now glucocorticoid therapy is recommended for patients with severe or active ophthalmopathy in children as well as in adults [1,7,16]. Morocco et al reported that pulse therapy resulted in a favorable clinical response in 88% of patients, as compared with a response rate of 63% in patients given oral glucocorticoid therapy, and that there were fewer side effects in the pulse therapy group than in the oral therapy group [17].…”

Section: Discussionmentioning

confidence: 99%

“…Morocco et al reported that pulse therapy resulted in a favorable clinical response in 88% of patients, as compared with a response rate of 63% in patients given oral glucocorticoid therapy, and that there were fewer side effects in the pulse therapy group than in the oral therapy group [17]. We adopted pulse therapy because erythema of the eyelids implied active ophthalmopathy [7] and a lower risk of side effects was expected. The dose was tolerated, but not fully effective.…”

Section: Discussionmentioning

confidence: 99%

“…Eye changes were class 2-0 according to the American Thyroid Association system that uses the mnemonic NOSPECS [7] because of lacrimation and inverted eyelashes.…”

Section: Case Reportmentioning

confidence: 99%

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An Infant Case of Graves' Disease with Ophthalmopathy

et al. 2005

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Abstract. Graves' disease is a rare disorder in children, particularly in infants. Ocular manifestations of Graves' disease in children are even more rare and are mild compared to adults. We report a 3-year-old girl with Graves' ophthalmopathy who visited our clinic because of lacrimation. Her family had also noticed exophthalmos, goiter, irritability and increased appetite for more than 3 months. The ophthalmologist noted bilateral proptosis, eyelid erythema, lacrimation, entropion of the lower eyelid, and superficial keratitis. Her serum concentrations of free thyroxine and free triiodothyronine were high, and thyroid-stimulating hormone (TSH) was low. Serum samples were markedly positive for antibodies to TSH receptor (TRAb) and thyroid-stimulating antibody (TSAb). Although hyperthyroidism was controlled with propylthiouracil within 3 weeks, her eye signs did not improve. We administered methylprednisolone pulse therapy for ophthalmopathy, but the effect was limited and the lacrimation due to entropion and superficial keratitis persisted. Titers of both TRAb and TSAb decreased slightly and transiently with the pulse therapy. One year later, both titers remained high and eye signs did not improve any more though she was clinically euthyroid. This might indicate that both TRAb and TSAb levels correlate with the clinical course. Therefore, TRAb or TSAb might be good indicators of progress of Graves' ophthalmopathy. Ocular manifestations of Graves' disease should be followed closely with measurements of both TRAb and TSAb even in infant cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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An Infant Case of Graves' Disease with Ophthalmopathy

et al. 2005

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“…Incidence of thyroid hence thyroid eye disease is more common in females (4:1) but severity of it is more commonly seen in males [3,4,5]. Most common clinical sign in TED is upper eyelid retraction (90%) followed by exophthalmos (60%) and eye movement restrictions (40%) [6]. Thyroid eye disease was considered as a part of the triad of Graves' disease which included orbital signs, hyperthyroidism and pretibial myxoedema [7].…”

Section: Introductionmentioning

confidence: 99%

Ophthalmic manifestations of thyroid disease and the association of serum levels of T3, T4 and TSH with thyroid eye disease

Choudhari

Usgaonkar

Shrivastav

2019

Trop J Ophthalmol Otolaryngol

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Aim: To study the ophthalmic manifestations in thyroid disease and the association of serum levels of T3, T4 and TSH with thyroid eye disease. Material and methods: The present study was a prospective case series study. It included 72 patients with thyroid disease with either hypo, hyper or euthyroid status visiting ophthalmology department from March to October 2019, at GMC, Bambolim, Goa. Data was entered on SPSS software and analysed by using one-way ANOVA test to study the proportions of thyroid eye disease signs in various thyroid disease types and to establish their relationship with serum levels of T3, T4 and TSH and the duration of thyroid disease. Result: The most common thyroid eye disease was found to be dry eye (41 patients) followed by upper lid retraction (19 patients) and proptosis (14 patients). Serum level of T3 at the time of study was found to be significantly correlated with the severity and the frequency of upper lid retraction. Serum levels of T4 at the time of diagnosis of hyperthyroid was found to be significantly related with the severity and the frequency of the proptosis. Rest all signs of thyroid eye disease (Chemosis, congestion, dry eye) and intraocular pressure were found to be not associated or related with serum levels of T3, T4 and TSH at the time of examination or at the time of diagnosis. Conclusion: Duration of thyroid disease was not found to be significantly related with the frequency and severity of any of the thyroid eye disease signs which were studied with the p value being more than 0.05 in each subgroup.

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“…Almost all patients with thyroid dysfunctions are thought to have GO, including a mild symptom,1,3 although 25%–50% of patients with Graves’ disease3 and 3% of those with Hashimoto thyroiditis4 have symptoms of GO. While Graves’ disease is easily diagnosed based on the typical signs and symptoms,1 the symptoms in hypothyroidism are much more subtle 4,5.…”

Section: Introductionmentioning

confidence: 99%

Double motion of upper eyelids in Graves’ orbitopathy: an additional sign for detection of thyroid dysfunction or positive thyroid autoantibodies

Kakizaki¹,

Takahashi²,

Iwaki³

et al. 2011

OPTH

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Purpose:To assess the effectiveness of the upper eyelid double motion sign in Graves’ orbitopathy (GO) in detecting thyroid dysfunction or a positive level of thyroid-related autoantibodies.Methods:GO was defined when more than two GO-related eyelid symptoms, including the double motion sign, existed with at least one positive thyroid-related blood test. Blood tests were performed in patients with more than two GO-related eyelid symptoms. The double motion was defined when the upper eyelid stopped at least once during downward eye movement. Fifty patients without GO or other eyelid diseases were used as controls.Results:There were 353 patients who showed more than two GO-related eyelid symptoms including the upper eyelid double motion sign. Of these, 300 patients were diagnosed with GO (300/353, 85.0%). The double motion sign was demonstrated in 267 patients (75.6%). A pause in double motion was typically seen around the anterosuperior direction of gaze. Double motion was not seen in any of the control eyelids. Although only 7.0% were hyperthyroid and 8.6% were hypothyroid, thyroid related autoantibodies were shown in 73.9% of patients. When the double motion sign was removed from the diagnostic criteria of GO, 263 patients had more than two thyroid-related eyelid symptoms, including 223 patients diagnosed as GO (25.7% reduction), although the rate of a correct diagnosis was almost the same (84.8%).Conclusions:The double motion sign of the upper eyelids is frequently demonstrated in GO patients. This previously unreported sign can help in detecting thyroid dysfunction states with positive levels of autoantibodies.

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Clinical Presentation and Natural History of Graves’ Ophthalmopathy

Cited by 5 publications

References 49 publications

An Infant Case of Graves' Disease with Ophthalmopathy

An Infant Case of Graves' Disease with Ophthalmopathy

Ophthalmic manifestations of thyroid disease and the association of serum levels of T3, T4 and TSH with thyroid eye disease

Double motion of upper eyelids in Graves’ orbitopathy: an additional sign for detection of thyroid dysfunction or positive thyroid autoantibodies

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Clinical Presentation and Natural History of Graves’ Ophthalmopathy

Cited by 5 publications

References 49 publications

An Infant Case of Graves' Disease with Ophthalmopathy

An Infant Case of Graves' Disease with Ophthalmopathy

Ophthalmic manifestations of thyroid disease and the association of serum levels of T3, T4 and TSH with thyroid eye disease

Double motion of upper eyelids in Graves&rsquo; orbitopathy: an additional sign for detection of thyroid dysfunction or positive thyroid autoantibodies

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Double motion of upper eyelids in Graves’ orbitopathy: an additional sign for detection of thyroid dysfunction or positive thyroid autoantibodies