Ophthalmopathy in childhood Graves' disease

Chan, Wai‐Man; Wong, Gary; Fan, Dorothy S. P.; Cheng, Arthur C.K.; Lam, Dennis Shun Chiu; Ng, Joan S.K.

doi:10.1136/bjo.86.7.740

Cited by 76 publications

(72 citation statements)

References 27 publications

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“…Graefe sign (lid lag), eyelid [1,5,6,32]. However, in rare cases myopathy and dysthyroid optic neuropathy (DON) in children and adolescents in course of Graves' disease may also occur [33].…”

Section: Symptoms and Signs Of Thyroidassociated Ophthalmopathymentioning

confidence: 99%

“…Apart from many clinical symptoms of Graves' disease such as goitre, tachycardia and acceleration of metabolism, TAO may develop in children as well. According to previous studies, the thyroid eye disease is usually mild with proptosis and soft tissue involvement as predominant manifestations [5][6][7][8]. Nevertheless the quality of life of children and adolescents with TAO may be impaired.…”

Section: Introductionmentioning

confidence: 99%

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An update on thyroid-associated ophthalmopathy in children and adolescents

Szczapa-Jagustyn¹,

Gotz‐Więckowska²,

Kocięcki³

2016

Journal of Pediatric Endocrinology and Metabolism

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Section: Symptoms and Signs Of Thyroidassociated Ophthalmopathymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An update on thyroid-associated ophthalmopathy in children and adolescents

Szczapa-Jagustyn¹,

Gotz‐Więckowska²,

Kocięcki³

2016

Journal of Pediatric Endocrinology and Metabolism

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“…Por esta razón, restaurar y mantener un estado eutiroideo es fundamental en pacientes con EG, especialmente en aquellos con OG 27 . Sin embargo, en estudios en población pediátrica 1,34 no se ha logrado remisión de los signos de OG a pesar de restaurar un estado eutiroideo, la explicación de esta respuesta disímil no ha sido aclarada.…”

Section: Disfunción Tiroideaunclassified

“…Estos síntomas son característicos de la OG en niños; mientras que las manifestaciones más severas como el estrabismo restrictivo, la neuropatía óptica distiroidea (NOD) y la quetaropatía por exposición son típicas del adulto. En una serie 33 de 120 pacientes adultos el estrabismo restrictivo alcanzó 42,5% y la NOD 5,8%, en comparación a una serie pediátrica 34 37 , no se encontraron diferencias por edad en la forma de presentación clínica de la OG. Una hipótesis que podría explicar la diferencia en severidad entre niños y adultos es la exposición al tabaco, ya que las manifestaciones clínicas de OG en pacientes pediátricos se asemejan a las del adulto cuando los pacientes entran en etapa de adolescencia, grupo en el cual la prevalencia de consumo de tabaco aumenta.…”

Section: Manifestaciones Clínicas (Tabla 1)unclassified

Orbitopatía de Graves en pediatría

2015

Rev. méd. Chile

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Graves' orbitopathy in pediatrics Graves' orbitopathy (GO) is rare in pediatric patients, however is the most common extrathyroid manifestation of Graves' disease (GD) camendoza@uc.cl caromendozafuentes@gmail.com E l hipertiroidismo autoinmune es la causa más común de tirotoxicosis en niños y adolescentes. La incidencia reportada en Europa es de 0,8/100.000 niños/año, con una relación por sexo femenino: masculino de 3-5:1 1 . La Orbitopatía de Graves (OG) es la manifestación extratiroidea más frecuente de la enfermedad de Graves (EG) y se presenta en 30-67% de los pacientes. Es una patología poco frecuente en pediatría y el riesgo de desarrollarla aumenta con la edad 2 . Al comparar por grupos etarios se observa una frecuencia de 31,8% en pacientes menores de 11 años versus 68,2% en adolescentes (11-18 años) 3 .La OG es una enfermedad inflamatoria autoinmune. Se asocia a hipertiroidismo autoinmune en 80-90% de los casos, 3-4% de los casos se presenta en pacientes con tiroiditis de Hashimoto y 5-10% en pacientes eutiroideos 4 . El 80% de los casos de OG se presenta dentro de los primeros 18 meses desde que se diagnostica la enfermedad tiroidea, sin embargo, se puede desarrollar antes o después de la aparición del hipertiroidismo 5 . FisiopatologíaLa patogenia de la OG está determinada por una infiltración perivascular difusa de linfocitos T CD4+, CD8+, linfocitos B, células plasmáticas y macrófagos; estas células liberan citoquinas inflamatorias y prostaglandinas las que inducen remodelación del tejido conectivo, lo que asociado a una infiltración de glicosaminoglicanos producen un aumento de volumen de los músculos extraoculares (MExO) y del tejido adiposo orbitario 6-7 . Fibroblasto orbitario (FO): la célula dianaActualmente se reconoce a los FO como las células diana en la OG 7-8 . Estudios sugieren que los linfocitos T CD8+ actuarían reconociendo a los FO y estimulando su proliferación vía complejo mayor de histocompatibilidad clase II. A diferencia de las células de los MExO, los FO expresan antígeno leucocitario humano (HLA-DR), los que actuarían como células presentadoras de antígenos 9 .

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“…CT Scanning or ultrasound may show enlarged extraocular muscles, but significantly limitation of ocular movement is rare and visually threatening problems have not been reported [3]. The condition generally shows a good prognosis for spontaneous resolution, usually without recurrence or need for major intervention such as intravenous steroids or decompression of orbit [4].…”

Section: Introductionmentioning

confidence: 99%

Ocular Manifestations of Pediatric Systemic Disease

Lim

2016

Hanyang Med Rev

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An ocular manifestation of a systemic disease is an ocular condition that directly or indirectly results from a pathologic process from another part of the body. Ocular manifestations can occur in various systemic diseases in pediatrics. However, ocular manifestations are difficult to recognize especially in pediatric diseases because most clinicians ignore ocular involvement of systemic diseases. Ocular manifestations can be the first findings of systemic disease in some pediatric disease, and numerous ocular manifestations can be associated with amblyopia, which is a disorder of sight. Therefore we must be able to recognize the ocular manifestations for diagnosis and management of pediatric systemic diseases.Although we cannot deal with ocular manifestations of all pediatric systemic disease in this paper, we have reviewed particular diseases that are may be of interest to the general physician and pediatric ophthalmologists. This paper aims to review the ocular manifestations of various pediatric diseases. HYPERTHYROIDISMHyperthyroidism is caused by over secretion of thyroid hormone; during childhood, it is caused by Graves' hyperthyroidism, the most common cause of pediatric hyperthyroidism [1]. In children, the incidence of Graves' disease is about 1:10,000 [2]. Graves' hyperthyroidism is an autoimmune disorder; secretion of thyroidstimulating immunoglobulin that binds to and triggers the Gprotein-coupled thyroid-stimulating hormone (TSH) receptor results in diffuse enlargement of the thyroid gland. Other etiologies of hyperthyroidism include gain-of-function germline mutations in the TSH receptor, which are detected in both familial and sporadic cases of non-autoimmune hyperthyroidism. These subjects, whose disease can occur in the infantile period or in later childhood, have a hyperplastic thyroid gland with goiter and decreased levels of TSH.Childhood onset Graves' ophthalmopathy is uncommon and occurs mostly in girls. Pediatric diseases are important because diagnosis and care for these can be complex. Among them, specific diseases have been associated with ocular involvement. This review presents the ocular manifestations of various pediatric diseases relevant to the clinician. An array of ocular manifestations of hyperthyroidism, hypoparathyroidism, diabetes mellitus, porphyria, cystinosis, mucopolysaccharidosis, Wilson disease, juvenile idiopathic arthritis, systemic lupus erythematosus, Marfan syndrome, Weill-Marchesani syndrome are describ ed. In this review we will review ocular manifestations of systemic pediatric diseases for comprehensive understanding of eye involvement. With this review, authors can recognize the ocular manifestations for diagnosis and management of pediatric systemic diseases.

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Ophthalmopathy in childhood Graves' disease

Cited by 76 publications

References 27 publications

An update on thyroid-associated ophthalmopathy in children and adolescents

An update on thyroid-associated ophthalmopathy in children and adolescents

Orbitopatía de Graves en pediatría

Ocular Manifestations of Pediatric Systemic Disease

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