The epidemiological characteristics of patients with thyroid eye disease in a referral center in northern Iran

Abstract

PurposeThis study was conducted to determine the demographics, clinical features, severity, and activity of thyroid eye disease (TED) in patients of a referral center in the north of Iran.MethodsPatients with TED who were referred to Amir-Almomenin Hospital, Rasht, Iran from March 2012 to March 2014 were enrolled in this cross-sectional study. The measurements of proptosis, lid width, lagophthalmos, extraocular muscle function, and visual acuity were recorded. The activity of ophthalmopathy was scored according to the clinical activity score (CAS).ResultsTED was diagnosed in 103 patients with a mean age of 42.1 ± 13.91 years. Of those patients, 52.4% were women, and 80% had hyperthyroidism. The mean duration of TED was 36.5 ± 53.12 months. Extraocular muscle involvement (98%) and eyelid retraction (88.3%) were the most common manifestations. Per the CAS results, 86 (83.5%) patients were at stage 0, and there was a significant difference in CAS scores between male and female patients, P = 0.02.ConclusionsThe characteristics of TED in patients of the studied referral center during a two-year period, including common signs and symptoms, disease duration, treatment, an activity of disease were determined. Notably, many patients in this study had orbital squeal of TED meaning that they had inactive TED. Proper management of this serious complication requires close cooperation between endocrinologists and ophthalmologists to ensure timely referrals for appropriate care.

Hypo vs. hyperthyroid eye disease: Is there any difference?

“…The sex distribution between Hr-TED and Ho-TED was signi cantly different in our study; however, like previous studies most of the patients in both groups were women. This is contrast to Kashkuli et al (8), Ekcstein et al ( 9) Leo et al ( 24) Medghalchi (12) ndings that showed no difference between Hr-TED and Ho-TED regarding sex distribution.…”

“…There is scarcity of data about contrasting clinical characteristics of hypo, hyper and euthyroid TED patients (11)(12)(13)(14)(15)(16)(17)(18)(19). In the present study we aimed to compare the clinical characteristics of hypo and hyperthyroid TED patients.…”

Prevalence of hyperthyroidism, hypothyroidism, and euthyroidism in thyroid eye disease: a systematic review of the literature

“…1001 were excluded because they had previous history of thyrotoxicosis or hyperthyroidism (we included these patients into the hyperthyroid group), 10 had subclinical thyrotoxicosis (these patients were added to the hyperthyroid group), and the other 9 patients were in hypothyroid or euthyroid status McKeag et al [ 28 ] Cross-sectional Thyroid function tests By ophthalmologist and imaging tests The criteria of the study included only patients with Graves’ thyrotoxicosis before or at the time of diagnosis of TED and only patients with primary hypothyroidism are named in the study. Medghalchi et al [ 29 ] Cross-sectional Thyroid function tests By ophthalmologist, imaging tests and visual field analysis The study did not mention possible causes of secondary hormonal status on the patients (following thyroid disease treatment) Mukasa et al [ 30 ] Cross-sectional Thyroid function tests By a specialized ophthalmological clinic All the patients included were untreated and were assessed for GO within 3 months of their initial visit to the hospital It is not clear if the prevalence of hypothyroidism was cero in this group or if at the beginning of the study these patients were excluded Ponto et al [ 31 ] Cross-sectional By a specialized autoimmune (endocrine) clinic By independent ophthalmologist or a specialized thyroid–eye clinic The primary hormone levels were measured according to the autoimmune-associated thyroid disease A limitation of this study is the underestimation of euthyroid patients. This study initially included patients with autoimmune thyroid disease (GD and Hashimoto’s thyroiditis), euthyroid patients were not included in the initial selection criteria and were gathered with hypothyroid patients Ponto et al [ 32 ] Cross-sectional Thyroid function tests By an ophthalmologist The primary thyroid status was measured 6 months before or after TED diagnosis NA Cozma et al [ 33 ] Cross-sectional By a specialized thyroid–eye clinic, thyroid function tests By a specialized thyroid-eye clinic Patients with normal thyroid function tests, no history of disease or treatment, no clinical signs or symptoms of thyroid disease were included NA …”

Effect of iodine-therapy on hyperthyroidism patients without pre-administration of anti-thyroid therapeutic options

“…Studies have shown that utilizing PTU (and not methimazole) before iodine therapy delays the therapeutic response. PTU is suggested to enhance thyroid tissue resistance against radioactive iodine 5,[42][43][44] . In a meta-analysis study performed on 1269 patients, drug therapy's risk of reducing the response to iodine therapy was approximately 1.28.…”