Clinical profile of thyroid eye disease and factors predictive of disease severity

Abstract

Purpose: To describe the clinical features of thyroid eye disease (TED) in patients presenting at a tertiary eye care centre in North India and to identify factors predictive of severe disease. Methods: This observational cross-sectional study involved clinical evaluation of all patients with TED who presented at the oculoplastic clinic based on the ITEDS VISA proforma. Risk factors for the severe disease were assessed using univariate and multivariate logistic regression. Results: A total of 106 patients (50 males, 56 females; mean age 41.30 ± 14.76 years) were identified during the study period, 46.23% hyperthyroid, 33.96% hypothyroid and 19.81% euthyroid. The proportion of the patients with hypothyroid was higher as compared with prior studies and most patients with hypothyroid had the mild disease (63.89%). Orbitopathy symptoms were the presenting feature leading to the diagnosis of systemic thyroid abnormality in 25% of the patients with hypothyroid and 59.18% of the patients with hyperthyroid, respectively ( P < 0.05). Eyelid and orbitopathy signs were more common in the patients with hyperthyroid (51.2% and 87.7%) as compared with hypothyroid where the commonest presenting symptoms were related to dry eye (50.1%). Active disease was seen in 22.6% of the patients. Mild, moderate to severe and sight-threatening disease was seen in 54.7%, 37.7% and 7.5%, respectively. On multivariate analyses, hyperthyroid status and activity was associated with severe disease. Smoking was not associated with activity or severity. Conclusion: There is no significant difference in the gender profile of the patients with TED in this cohort. The patients with hypothyroid have a milder disease compared to the patients with hyperthyroid, and dry eye symptoms are the commonest presenting symptoms in hypothyroid subjects. Hyperthyroidism and activity were associated with severe and sight-threatening disease.

Sight-Threatening Thyroid Eye Disease: Role of Diabetes Mellitus and Interaction with Other Risk Factors

“…25 Finally, a prospective series of 106 TED patients from northern India reported by Muralidhar et al found both DM and history of smoking did not reach statistical significance as risk factors for severe TED. 26 The quick succession of the 3 reports corroborate that the question about the role of DM in the severity and outcome of TED is relevant. [24][25][26] However, the role of DM as risk factor is conflicting in the above reports.…”

“…26 The quick succession of the 3 reports corroborate that the question about the role of DM in the severity and outcome of TED is relevant. [24][25][26] However, the role of DM as risk factor is conflicting in the above reports. [24][25][26] The best way forward is to devise a multicenter prospective adequately powered study in regions with high prevalence of DM to explore and formulate optimal management strategies for TED with DM.…”

“…22 In the recent past 3 different groups from the Indian subcontinent have reported on the role of co-existing morbidities including DM on the severity of TED. [24][25][26] Ramamurthy et al in a retrospective series of 105 TED patients found type 2 DM was a risk factor for sight-threatening TED. 24 Another large retrospective series of 301 patients reported by Gupta et al found DM along with older age and male gender as risk factors for visual morbidity (sight-threatening disease and diplopia) in TED.…”

“…[24][25][26] However, the role of DM as risk factor is conflicting in the above reports. [24][25][26] The best way forward is to devise a multicenter prospective adequately powered study in regions with high prevalence of DM to explore and formulate optimal management strategies for TED with DM.…”

A comparative review of evaporative dry eye disease and meibomian gland dysfunction in dogs and humans

“…2,4 In dogs, this syndrome is well characterized and commonly referred to as keratoconjunctivitis sicca, yet more recent literature has utilized the term ADDE to highlight the similarities with human disease. 30 Additional causes of ADDE in humans and/or dogs include disrupted neuronal stimulation of the lacrimal gland, 31,32 drug-induced (e.g., atropine, sulfa-containing oral antibiotics), 33,34 hypothyroidism, 35,36 diabetes mellitus, 35,37 trauma, congenital alacrima, 38,39 (e.g., distemper virus), 40 and surgical excision of the gland of the third eyelid. 41…”