Update on thyroid eye disease and management

Bothun, Erick D.; Scheurer, Ryan A.; Harrison, Andrew R.; Lee, Michael S.

doi:10.2147/opth.s5228

Cited by 32 publications

(24 citation statements)

References 68 publications

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“…A complete understanding of the pathophysiology of TED has not been delineated, but evidence suggests that disease pathogenesis is related to loss of self-tolerance to thyroid-stimulating hormone receptor (TSH-R) and overexpression of IGF-1R 8,25–27. The autoimmune orbital response occurs in TED because of cross-reactivity against antigens that are present in both the thyroid gland and orbital tissue, although the exact pathophysiology is still unclear 11,28. It appears that the production of thyroid-stimulating immunoglobulins (TSIs) mimics thyroid-stimulating hormone (TSH), leading to excessive thyroid hormone production and amplified actions on target tissues expressing TSH-R (ie, orbital fat, extraocular muscle, and orbital fibroblasts) 25.…”

Section: Molecular Biology Of Thyroid Eye Diseasementioning

confidence: 99%

“…The disease then progresses to stable, chronic, fibrotic, inactive disease. Despite reduced inflammation, permanent damage may result and patients do not typically experience significant clinical improvement, responding only to surgery at this point 11Figure 3An approximation of a curve depicting severity of thyroid eye disease over time that is based on a concept by Rundle 110…”

Section: Clinical Characteristics and Diagnostic Criteria Of Thyroidmentioning

confidence: 99%

“…The list can be expanded to 10 symptoms for follow-up 52. There are several classification systems in rather limited use (eg, NOSPECS [No physical signs or symptoms, Only signs, Soft tissue involvement, Proptosis, Extraocular muscle signs, Corneal involvement, and Sight loss; Table 2], VISA [Vision, Inflammation, Strabismus, and Appearance], and EUGOGO) 11,52Table 1Clinical Activity Score a CASFor initial assessment, only score items 1–71Spontaneous orbital pain2Gaze evoked orbital pain3Eyelid swelling; considered due to active TED4Eyelid erythema5Conjunctival redness; considered due to active TED6Chemosis7Inflammation of caruncle or plica Follow-up assessment at 1–3 months can be scored out of 10 8Increase of >2mm in proptosis9Decrease in uniocular excursion in any one direction of >8 degrees10Decreased acuity equivalent to 1 Snellen line Note: One point is given for the presence of each parameter.…”

Section: Clinical Characteristics and Diagnostic Criteria Of Thyroidmentioning

confidence: 99%

“…doi:10.2147/opth.s5228. Creative Commons License and Disclaimer available from: http://creativecommons.org/licenses/by/4.0/legalcode 11 Abbreviations: NOSPECS, No physical signs or symptoms, Only signs, Soft tissue involvement, Proptosis, Extraocular muscle signs, Corneal involvement, and Sight loss. …”

Section: Clinical Characteristics and Diagnostic Criteria Of Thyroidmentioning

confidence: 99%

“…doi:10.2147/opth.s5228. Creative Commons License and Disclaimer available from: http://creativecommons.org/licenses/by/4.0/legalcode 11…”

Section: Clinical Characteristics and Diagnostic Criteria Of Thyroidmentioning

confidence: 99%

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<p>Thyroid Eye Disease: How A Novel Therapy May Change The Treatment Paradigm</p>

Wang¹,

Patel²,

Douglas³

2019

TCRM

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Thyroid eye disease (TED) is a complex, debilitating autoimmune disease that causes orbital inflammation and tissue remodeling, resulting in proptosis, diplopia, and in severe cases, loss of vision. TED can lead to facial disfigurement and severely impact patients' quality of life. Although the course of TED was identified over 60 years ago, effective treatment options have proved to be challenging. Current treatments such as glucocorticoid therapy and orbital radiation focus on reducing orbital inflammation. However, these therapies fail to modify the disease outcomes, including proptosis and diplopia. Recent advances in the understanding of the molecular basis of TED have facilitated the development of targeted molecular therapies such as teprotumumab, an insulin-like growth factor-1 receptor inhibiting monoclonal antibody. In recent phase 2 and phase 3 randomized placebo-controlled trials, teprotumumab rapidly achieved improvement in clinical endpoints defining TED, including improved proptosis and diplopia. Dramatic improvement in clinical outcomes achieved after teprotumumab therapy during active TED are heretofore singular and comparable only to surgical therapies achieved during the inactive phase of TED. The advent of effective medical therapy can lead to a paradigm shift in the clinical management of TED. This review will provide an overview of TED, its epidemiology, insight into the molecular biology of the disease, clinical characteristics and diagnosis, and current and emerging treatment modalities.

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Section: Molecular Biology Of Thyroid Eye Diseasementioning

confidence: 99%

Section: Clinical Characteristics and Diagnostic Criteria Of Thyroidmentioning

confidence: 99%

Section: Clinical Characteristics and Diagnostic Criteria Of Thyroidmentioning

confidence: 99%

Section: Clinical Characteristics and Diagnostic Criteria Of Thyroidmentioning

confidence: 99%

“…doi:10.2147/opth.s5228. Creative Commons License and Disclaimer available from: http://creativecommons.org/licenses/by/4.0/legalcode 11…”

Section: Clinical Characteristics and Diagnostic Criteria Of Thyroidmentioning

confidence: 99%

See 3 more Smart Citations

<p>Thyroid Eye Disease: How A Novel Therapy May Change The Treatment Paradigm</p>

Wang¹,

Patel²,

Douglas³

2019

TCRM

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Fractional anisotropy and diffusivity changes in thyroid-associated orbitopathy

et al. 2016

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Dry eye syndrome: comprehensive etiologies and recent clinical trials

Huang

Fang

et al. 2022

Int Ophthalmol

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Dry eye syndrome (DES) is multifactorial and likely to be a cause of concern more so than ever given the rapid pace of modernization, which is directly associated with many of the extrinsic causative factors. Additionally, recent studies have also postulated novel etiologies that may provide the basis for alternative treatment methods clinically. Such insights are especially important given that current approaches to tackle DES remains suboptimal. This review will primarily cover a comprehensive list of causes that lead to DES, summarize all the upcoming and ongoing clinical trials that focuses on treating this disease as well as discuss future potential treatments that can improve inclusivity.

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Update on thyroid eye disease and management

Cited by 32 publications

References 68 publications

<p>Thyroid Eye Disease: How A Novel Therapy May Change The Treatment Paradigm</p>

<p>Thyroid Eye Disease: How A Novel Therapy May Change The Treatment Paradigm</p>

Fractional anisotropy and diffusivity changes in thyroid-associated orbitopathy

Dry eye syndrome: comprehensive etiologies and recent clinical trials

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