Untreated Graves' disease patients without clinical ophthalmopathy demonstrate a high frequency of extraocular muscle (EOM) enlargement by magnetic resonance

Villadolid, Maria C.

doi:10.1210/jc.80.9.2830

Cited by 45 publications

(16 citation statements)

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“…Unlike previous studies looking at the relationship between RAI and TAO, the clinical findings in this study are supported by an objective measure of ophthalmopathy, namely orbital MRI, which is superior to clinical assessment for the detection of EOM involvement [16].…”

Section: Discussionsupporting

confidence: 40%

Association between radioiodine therapy for Graves’ hyperthyroidism and thyroid-associated ophthalmopathy

et al. 2010

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To investigate the role of radioactive iodine (RAI) in the onset and progression of thyroid-associated ophthalmopathy (TAO). Forty-six Graves' disease patients with mild or no ophthalmopathy were prospectively treated with carbimazole (CBZ) (n = 22) or RAI (n = 24). Treatment effects were evaluated clinically over 12 months, and with orbital MRI-measured extra-ocular muscle (EOM) volumes at baseline and at 6 months. The diagnosis of TAO was based on the clinical activity score (CAS) system. There were 11/22 CBZ and 10/24 RAI patients with active ophthalmopathy at baseline. Despite greater mean TSH levels post-RAI (P = 0.003), there was no increase in the likelihood of developing active ophthalmopathy (OR 0.95; 95% CI 0.56-1.61, P = 0.9) or EOM dysfunction (OR 0.52; 95% CI 0.26-1.06, P = 0.074). The increased mean palpebral aperture post-RAI (P = 0.023) and greater mean proptosis in the CBZ group (P = 0.005) were not confirmed when the absolute values of these measurements were examined. There was no association between the treatment received and MRI-measured EOM volumes. In this study, RAI therapy for Graves' disease did not increase the risk of progression or development of ophthalmopathy in patients with mild or no eye disease at baseline.

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Section: Discussionsupporting

confidence: 40%

Association between radioiodine therapy for Graves’ hyperthyroidism and thyroid-associated ophthalmopathy

et al. 2010

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“…The ophthalmopathy associated with Graves’ hyperthyroidism and, less often, Hashimoto’s thyroiditis [10] is presumed to be an autoimmune disorder of the extraocular muscles and orbital connective tissue. There is substantial evidence that the eye muscles are targets of the autoimmune reactions of “thyroid-associated ophthalmopathy” because more than 90% of Graves’ patients with or without clinical signs of ophthalmopathy have extraocular muscle enlargement by orbital imaging techniques [23]. …”

Section: Discussionmentioning

confidence: 99%

Eye findings and immunological markers in probands and their euthyroid relatives from a single family with multiple cases of thyroid autoimmunity

et al. 2012

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BackgroundOphthalmopathy is a common manifestation of Graves’ disease (GD) occurring in up to 50% of patients. Mild eye signs are also common in patients with Hashimoto’s thyroiditis. Whilst a genetic predisposition to GD has been demonstrated this is not the case for the ophthalmopathy which often runs a separate course.ObjectiveWe determined the prevalences of eye and eyelid signs and positive thyroid and orbital antibody tests in first and second degree relatives from a single family with multiple cases of Graves’ disease, ophthalmopathy and Hashimoto’s thyroiditis.DesignThe study cohort comprised 16 subjects from the same family, 4 probands namely, 3 with GD and one with Hashimoto’s thyroiditis and hypothyroidism and 12 of their euthyroid first or second degree relatives. We measured antibodies against calsequestrin (CASQ1) and collagen XIII in an enzyme-linked-immunosorbent assays and TSH-Receptor (TSH-R) antibodies as i) TSH-R binding inhibiting immunoglobulin (TBII) and ii) thyroid stimulating immunoglobulin (TSI). Eye signs were classified and quantified using the clinical activity score (CAS), NOSPECS classes, Nunery types 1 and 2 and the margin-reflex-distance (MRD) as a measure of upper eyelid retraction (UER).Main outcomesWhilst significant ophthalmopathy was uncommon in the relatives, mild eye signs, in particular UER, were demonstrated in about a third of them. The presence of eye signs was moderately, but not significantly, associated with the detection of CASQ1 and collagen XIII antibodies, but not TSH-R antibodies.ConclusionOur study demonstrates a significant prevalence of positive orbital antibody tests and ophthalmopathy in probands with thyroid autoimmunity and their euthyroid relatives, favouring a role of genetic factors in the development of ophthalmopathy in patients with thyroid autoimmunity.

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“…The muscles mostly affected in our patients were the inferior rectus, the medial rectus and the superior rectus muscles. In larger series of MRI in Graves’ disease, it is the inferior rectus muscle that is most severely affected [8]. Normally more than one muscle is enlarged; orbital involvement is not symmetric, and one side may precede the other by several years.…”

Section: Discussionmentioning

confidence: 99%

Pure Eye Muscle Involvement in Endocrine Orbitopathy

Gerlach

Ferbert²

2008

Eur Neurol

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We present a long-term follow-up examination concerning patients with isolated extra-ocular muscle involvement in thyroid-related orbitopathy. Within the previous 13 years we observed 7 patients with endocrine orbitopathy and marked myopathy of the extra-ocular muscles. Five of these patients had no detectable proptosis, 2 of them showed a minimal unilateral proptosis. Five patients showed elevated thyroid-stimulating hormone (TSH) receptor auto-antibodies and 6 patients a marked swelling of the extra-ocular eye muscles on CT or MRI scans. One patient had elevated antibodies against thyroid peroxidase and against thyroglobulin and normal TSH receptor auto-antibodies. Four of 7 patients underwent clinical and radiological follow-up examination 1–9 years later. In 3 of these 4 patients, the clinical syndrome had completely resolved. None of the patients had developed any proptosis. The swelling of the eye muscles on radiological imaging had at least partially resolved. We conclude from our results that apart from the frequent subtype of endocrine orbitopathy with predominant proptosis there is a separate subtype in which proptosis neither exists initially nor develops in the further course. Probably these subtypes have a specific immunological antibody profile although they do not differ concerning the thyroid-stimulating antibodies.

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Untreated Graves' disease patients without clinical ophthalmopathy demonstrate a high frequency of extraocular muscle (EOM) enlargement by magnetic resonance

Cited by 45 publications

References 0 publications

Association between radioiodine therapy for Graves’ hyperthyroidism and thyroid-associated ophthalmopathy

Association between radioiodine therapy for Graves’ hyperthyroidism and thyroid-associated ophthalmopathy

Eye findings and immunological markers in probands and their euthyroid relatives from a single family with multiple cases of thyroid autoimmunity

Pure Eye Muscle Involvement in Endocrine Orbitopathy

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