Medical management of thyroid eye disease – A paradigm shift

Honavar, Santosh G

doi:10.4103/ijo.ijo_2386_20

Cited by 4 publications

(3 citation statements)

References 24 publications

(25 reference statements)

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Section: Management For Active Tedmentioning

confidence: 99%

“…These treatments have the advantage of targeting immune cells and receptors implicated in the pathogenesis of TED, with potentially better safety profile and greater efficacy compared to traditional approaches. [73][74][75][76][77][78] Rituximab. Rituximab is a monoclonal antibody against CD20 that depletes the population of autoreactive B cells by both the antibody-and complement-mediated pathways.…”

Section: Targeted Therapiesmentioning

confidence: 99%

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Updates on the understanding and management of thyroid eye disease

2021

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Thyroid eye disease (TED) is a complex disease associated with myriad clinical presentations, including facial disfigurement, vision loss, and decreased quality of life. Traditionally, steroid therapy and/or radiation therapy were commonly used in the treatment of active TED. While these therapies can help reduce inflammation, they often do not have a sustainable, significant long-term effect on disease outcomes, including proptosis and diplopia. Recent advances in our understanding of the pathophysiology of TED have shifted the focus of treatment toward targeted biologic therapies. Biologics have the advantage of precise immune modulation, which can have better safety profiles and greater efficacy compared to traditional approaches. For instance, the insulin-like growth factor-1 receptor (IGF-1R) has been found to be upregulated in TED patients and to colocalize with the thyroid-stimulating hormone receptor (TSHR), forming a signaling complex. Teprotumumab is an antibody targeted against IGF-1R. By inhibiting the IGF-1R/TSHR signaling pathway, teprotumumab may reduce the production of proinflammatory cytokines, hyaluronan secretion, and orbital fibroblast activation in patients with TED. Due to promising phase II and III clinical trial results, teprotumumab has become the first biologic US Food and Drug Administration (FDA)-approved for the treatment of TED. In addition, there are currently ongoing studies looking at the use of antibodies targeting the neonatal Fc receptor (FcRn) in various autoimmune diseases, including TED. FcRn functions to transport immunoglobulin G (IgG) and prevent their lysosomal degradation. By blocking the recycling of IgG, this approach may dampen the body’s immune response, in particular the pathogenic IgG implicated in some autoimmune diseases. Advances in our understanding of the pathophysiology of TED, therefore, are leading to more targeted therapeutic options, and we are entering an exciting new phase in the management of TED. This review will cover recent insights into the understanding of TED pathophysiology and novel treatment options as well as ongoing studies of new potential treatment options for TED.

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Section: Management For Active Tedmentioning

confidence: 99%

Section: Targeted Therapiesmentioning

confidence: 99%

Updates on the understanding and management of thyroid eye disease

2021

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“…Meiboscore might help treat the symptoms associated with MGD, while other forms of management of the disease might include the treatment of the pathophysiological mechanism of MGD as an intervention against this disorder [5,10,12] . Honavar [13] claimed that each step in categorizing DED and initiating appropriate management is important and that the mere use of artificial tears will not do justice to the management of DED. Meibomian Gland Disfunction MGD is a condition that results from a malfunction of the meibomian glands.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2023

Int J Ophthalmol

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AIM: To report ocular changes in rabbits after the implementation of three different induction methods to create dry eye (DE) conditions and provides evidence of DErelated disease evolution.• METHODS: Experimental methods were divided into 3 models. The first model used involved triple injection of complete Freund's adjuvant, 50 µL each, also called the meibomian gland dysfunction (MGD) model. In the second model, DE conditions were created by the resection of nictitating membranes (NM), Harderian glands (HG), and main lacrimal glands (LG), also called the LGR model. The third model involved the topical administration of benzalkonium chloride (BAK) 0.1% solution. The Schirmer test, ocular surface staining with fluorescein, and tear breakup time tests were implemented before and after excision. After euthanasia, the ocular tissues were dissected. Cornea, conjunctiva, and meibomian glands were treated with periodic acid-Schiff (PAS) staining and haematoxylin-eosin staining.• RESULTS: The MGD model triggered inflammation of meibomian glands. It detected changes in the lipid layer of the tear film. The bilateral resection of NM, HG, and LG reduced the watering layer of the tear film. The topical administration of BAK of 0.1% solution impacted the mucosal layer of the tear film.• CONCLUSION: Different changes are observed with different DE syndrome models. The composition of the tear film differ depending on which part of the eye is targeted. More studies need to be done to confirm whether an increased thickness of the cornea has any impact on the DE disease.

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Thyroid associated orbitopathy

Behera

Das

Dora

et al. 2022

Odisha Journal of Ophthalmology

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Thyroid-associated orbitopathy (TAO) is the most frequent extrathyroidal manifestation of Graves’ disease. It is an autoimmune process affecting the retrobulbar tissue. It is the most common cause of bilateral and unilateral exophthalmos among adults. The clinical presentation may vary from mild disease to severe irreversible sight-threatening complications. Till date, TAO remains a major diagnostic and therapeutic challenge. Diagnosis of orbitopathy is mainly clinical and treatment is based on the clinical severity of the disease. In this article, we review the pathophysiology, epidemiology, classification, clinical presentation, and management of this common yet challenging orbital inflammatory disease.

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Medical management of thyroid eye disease – A paradigm shift

Cited by 4 publications

References 24 publications

Updates on the understanding and management of thyroid eye disease

Updates on the understanding and management of thyroid eye disease

Untitled

Thyroid associated orbitopathy

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