Graves' Ophthalmopathy Research Articles

Monocyte-to-high-density lipoprotein ratio and systemic immune-inflammation index: Potential parameters for the evaluation of disease activity and severity in Graves' ophthalmopathy?

To assess changes in monocyte-to-high-density lipoprotein (HDL) ratio (MHR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) with Graves' ophthalmopathy (GO) and their possible relation with GO disease activity and severity. A total of 20 patients with GO and 24 healthy controls were involved in the study. The thyroid status, MHR (monocyte count/HDL cholesterol level), NLR (neutrophil count/lymphocyte count) and SII [(neutrophil count × platelet count)/lymphocyte count] were compared between the groups. The relation of systemic inflammation parameters with disease activity and severity was evaluated. The mean Clinical Activity Score (CAS) was 0.75 ± 0.78 in the GO group. None of the patients were active. The severity was mild for 14 (70.0%) patients and moderate-to-severe for 6 (30.0%) patients. MHR (17.28 ± 5.56 vs. 13.28 ± 5.08), NLR (2.51 ± 1.09 vs. 1.69 ± 0.53) and SII [600.42 (391.79-837.16) vs. 413.69 (344.26-603.82)] values were significantly increased in GO patients than in the controls (p = 0.017, p = 0.005 and p = 0.036, respectively). CAS was significantly correlated with MHR (r = 0.815, p < 0.001), NLR (r = 0.768, p = 0.017) and SII (r = 0.837, p < 0.001). The severity of GO was associated with increased MHR, NLR and SII (p = 0.019, p = 0.036 and p = 0.008, respectively). ROC analysis demonstrated that MHR, NLR and SII have a good ability to differentiate GO patients from healthy individuals. GO patients have higher MHR and SII levels than healthy controls. Higher MHR, NLR and SII values were associated with increasing disease severity and activity, supporting the efficacy of these non-invasive, low-cost markers in determining the course of GO. Future prospective controlled trials are needed to elucidate the relation between inflammatory markers and GO.

The Role of Fibrogenesis and Extracellular Matrix Proteins in the Pathogenesis of Graves' Ophthalmopathy.

Graves' ophthalmopathy (GO), or thyroid eye disease (TED), is the most frequent extrathyroidal manifestation of Graves' disease (GD). Inflammation and subsequent aberrant tissue remodeling with fibrosis are important pathogenesis. There are many proposed mechanisms and molecular pathways contributing to tissue remodeling and fibrosis in GO, including adipogenesis, fibroblast proliferation and myofibroblasts differentiation, oxidative stress, endoplasmic reticulum (ER) stress, hyaluronan (HA) and glycosaminoglycans (GAGs) accumulation in the extracellular matrix (ECM) and new concepts of epigenetics modification, such as histone modification, DNA methylation, non-coding RNAs, and gut microbiome. This review summarizes the current understanding of ECM proteins and associated tissue remodeling in the pathogenesis and potential mediators for the treatment of GO.

Causality of blood metabolites and metabolic pathways on Graves' disease and Graves' ophthalmopathy: a two-sample Mendelian randomization study.

There is ample that metabolic dysregulation is involved in Graves' disease (GD) and Graves' ophthalmopathy (GO). Recent studies have identified numerous metabolites associated with GD and GO. However, the causal impact of metabolites on GD and GO remains to be investigated. This two-sample Mendelian randomization (MR) analysis investigated the causal relationships between 486 blood metabolites and GD and GO. Sensitivity analysis was also performed to examine heterogeneity and pleiotropy. MR analysis showed that 9 and 13 metabolites were associated with GD and GO, respectively, each meeting the nominal significance criteria (inverse variance weighted, p < 0.05). Additionally, four metabolic pathways were identified for each condition using network-based MetaboAnalyst 5.0. The metabolites and pathways discovered in this study could serve as circulating metabolic biomarkers for clinical screening and prevention of GD and GO. They can be also used for further studies on the mechanisms and drug targets in GD and GO.

Assessment of Schlemm’s canal with swept-source optical coherence tomography in Graves’ ophthalmopathy

PurposeTo evaluate the Schlemm’s canal (SC) parameters obtained by swept-source optical coherence tomography (OCT) different in Graves’ ophthalmopathy (GO) eyes compared to healthy eyes.MethodsThis cross-sectional observational study evaluated 64 eyes of 32 GO cases and 56 eyes of 28 healthy controls. The study was conducted between October 2020 and June 2021. SC images were obtained from the temporal limbus of individuals using swept-source OCT. SC length (SCL) and SC area (SCA) were measured. The relationship between SC parameters in the patient group and intraocular pressure (IOP), retinal nerve fiber layer (RNFL) thickness, Graves’ disease (GD) duration, and clinical activity score (CAS) was evaluated.ResultsIn the GO group, 64 eyes of 32 patients were evaluated, and in the age and gender-matched healthy control group, 56 eyes of 28 individuals were assessed. SC images from 4 eyes of 4 patients in the patient group and 1 eye of 1 patient in the control group were not clear, preventing SCL and SCA measurements for these eyes. SCL and SCA measurements were found to be lower, and IOP and Hertel values were higher in the GO group compared to the healthy controls. However, no significant correlation was observed between SCL and SCA with IOP, RNFL thickness, GD duration, GO duration, or CAS in the GO group. In the GO group, the mean value of SCA was found to be higher in eyes with glaucoma or OHT compared to those without.ConclusionThese findings indicate that SC in GO-affected eyes is shorter and has a smaller area than in healthy individuals. Additionally, higher IOP and Hertel values were observed in the GO group compared to healthy controls. This study suggests that assessing SC using anterior segment OCT could provide valuable insights into the regulation of IOP and the development of glaucoma in GO-affected eyes.

Validation of Indonesian Graves’ Ophthalmopathy Quality of Life Questionnaire and Its Association with Clinical Activity and Severity of Graves’ Ophthalmopathy

Abstract&#x0D; Introduction &amp; Objectives : Graves' ophthalmopathy (GO) ocular abnormalities persisted even after treatment, negatively impacting the patient's psychological and social health. The Indonesian Graves' Ophthalmopathy Quality of Life (GO-QoL) Questionnaire has not been validated; hence it cannot measure patient quality of life in Indonesia, which is crucial to GO treatment. This objective of this study is providinga reliable Indonesian GO-QoL questionnaire and identifying an association between patient quality of life and clinical activity and severity of GO.&#x0D; Methods : The cross-sectional study ran from May through October 2022. Graves' ophthalmopathy and thyroid disease management were the inclusion criteria. Those who could not be reached by video call or controlled for two weeks for test-retest data collection were excluded. The process of questionnaire validation involves transcultural adaptation and cross-sectional design. The content validity index (CVI) and Cronbach's alpha assessed validity and reliability, respectively.&#x0D; Results : Content validity index (CVI) was 1.00 for the Indonesian GO-QoL questionnaire. Cronbach's alpha visual function subscale value was 0.971, while the appearance subscale value was 0.993, and the total score was 0.986. The appearance subscale and total score of GO patients' quality of life had a significant association with the clinical activity score (p&lt;0.05) and disease severity (p&lt;0.001).&#x0D; Conclusion : The Indonesian version of the GO-QoL questionnaire has high validity and reliability values. Patients' appearance and overall quality of life decreases with active Graves' ophthalmopathy. Graves' ophthalmopathy severity decreases quality of life on the appearance and overall subscales.

CORRELATION BETWEEN DEGREE OF PROPTOSIS WITH EYE BALL DIMENSION IN GRAVES OPHTHALMOPATHY PATIENT AT WAHIDIN SUDIROHUSODO HOSPITAL MAKASSAR

Abstract&#x0D; Introduction &amp; Objectives : Introduction Hyperthyroidism is one of the cause of Graves’ Ophthalmopathy (GO), which is an autoimmune orbital disease. Clinical manifestations of GO are orbital and periorbital edema, eyelid retraction, eyelid lag in down gaze, restrictive strabismus, compressive optic neuropathy, and keratopathy exposure. We can also find proptosis in GO patient. this happened because the expansion of adipose tissue and muscle at the edge of the orbital bones resulting in increased intraorbital pressure. Protrusion of eyeball can cause changes in the dimensions of the eyeball such as axial length, anterior chamber depth, and cornea curvature. Objective To assess the correlation of degree of proptosis with eyeball dimension in Patients Graves’ Ophthalmopathy.&#x0D; Methods : This research was a cross sectional study. A total of seventeen eyes were proptotic from patient with Graves' ophthalmopathy. They underwent measurement with a Hertel exophthalmometer and optical biometry to record the degree of proptosis, axial length, anterior chamber depth, and cornea curvature.&#x0D; Results : Patient with proptosis in Graves' Ophthalmopathy. This study analysed the degree of proptosis with axial length, anterior chamber depth, and cornea curvature. There is no statistically significant result.&#x0D; Conclusion : There was no correlation between degree of proptosis with axial length, anerior chamber depth, and cornea curvature in patient with Graves’ Ophthalmopathy.

Comparison of Changes in Quality of Life Based on Changes in Disease Severity in Graves Ophthalmopathy Patients Following Intraorbital Triamcinolone Acetonide Injection

Abstract&#x0D; Introduction &amp; Objectives : Graves ophthalmopathy (GO) is associated with visual impairment and appearance changes, affecting the quality of life. Intraorbital injection of triamcinolone acetonide (TCA) in GO resulted in clinical improvement, but its effect on the quality of life is unknown. The objective of this study was to compare the changes in quality of life after intraorbital injection of TCA between different groups based on changes in disease severity.&#x0D; Methods : Intraorbital injection of TCA was performed on 30 subjects with GO. Disease severity was assessed according to the European Group of Graves Ophthalmopathy (EUGOGO) criteria. Quality of life was measured using the Indonesian version of Graves Ophthalmopathy Quality of Life (GO-QOL) questionnaire. Changes in disease severity and GO-QOL scores were recorded before intraorbital injection of TCA and 1 month after. Subjects were divided into groups based on changes in disease severity: decreased, remained constant, and increased. Changes in quality of life between the groups were compared statistically.&#x0D; Results : Changes in GO-QOL appearance scores in patients with decreased disease severity were significantly higher (p= 0.016) than those in patients whose disease severity remained constant. Changes in GO-QOL visual function scores in patients with decreased disease severity were higher but not statistically significant (p&gt; 0.05) compared to those in patients whose disease severity remained constant.&#x0D; Conclusion : Changes in the appearance aspect of quality of life after intraorbital injection of TCA in patients with decreased disease severity are better than that in patients whose disease severity remained constant, whereas changes in the visual function aspect are not significantly different.

CORRELATIONSHIP BETWEEN THE LEVEL OF THYROTROPIN RECEPTOR ANTIBODY WITH ACTIVITY AND SEVERITY OF GRAVES’ OPHTHALMOPATHY AT WAHIDIN SUDIROHUSODO HOSPITAL MAKASSAR

Abstract&#x0D; Introduction &amp; Objectives : Graves’ Ophthalmopathy (GO) is an autoimmune orbital disease with mostly occurs along with hyperthyroidism. The underlying cause of GO is theoretically connected with thyrotropin receptor that activated antigen-presenting cells from thyrotropin-receptor peptides, then attached with T- helper and B cell that produce the level of thyrotropin receptor antibody (TRAb) and cause an enlargement of orbital tissue and increase the level of triiodothyronine (T3) and thyroxine (T4). To determine the active manifestation status from those clinical findings, the Clinical Activity Score (CAS) is utilised. Meanwhile, European Group on Graves' Orbitopathy (EUGOGO) is used to classify the severity of the disease. This research aims to assess the correlation of TRAb levels toward its activity and severity in patients with Graves’ Ophthalmopathy.&#x0D; Methods : Thirty-four patients with Graves’ Ophthalmopathy underwent clinical and laboratory examinations. The result of clinical finding was plotted into CAS to determine its activity status and EUGOGO to classify its severity. TRAb concentration was measured with ELISA or TBII Assays.&#x0D; Results : All patients have high level TRAb. We analysed the level of TRAb with activity and severity. We found a significant result of cofounding variables related to gender and smoking history, with P value 0.011 and 0.017 respectively. There is no statistically significant result TRAb with activity (CAS) P=0.465, and TRAb with Severity (EUGOGO) P=0.812.&#x0D; Conclusion : The level of TRAb is primarily used as diagnostic marker for Graves’ Ophthalmopathy, but they haveno correlation from the level of TRAb with activity and severity patient with Graves’ Ophthalmopathy.

Bridging and Validation of the Specific Graves Ophthalmopathy Quality of Life Questionnaire With Health State Utility Values

ObjectiveIn thyroid eye disease (TED), inflammation and expansion of orbital muscle and periorbital fat result in diplopia and proptosis, severely impacting patient quality of life (QOL). The reported health state utility (HSU) scores, which are QOL measures, allow quantification of TED impact and improvement with therapies; however, no current QOL instrument has been validated with HSU scores for TED. Here, we used the disease-specific Graves Ophthalmopathy Quality of Life (GO-QOL) questionnaire and HSU scores to validate QOL impact. MethodsThe GO-QOL scores from patients in 2 randomized, masked, placebo-controlled teprotumumab trials (N=171) were compared with 6 HSU values based on severity of proptosis/diplopia in those studies. Patient GO-QOL and HSU scores were compared at baseline and after 6-month treatment via regression analyses. GO-QOL and HSU scores were correlated for validation and quantification of QOL impact by severity state and to estimate quality-adjusted life year improvement. ResultsGO-QOL scores were correlated with TED severity, indicating that worse severity was associated with lower (worse) GO-QOL scores. Less severe health states were represented by higher (better) GO-QOL scores. Importantly, GO-QOL scores were positively correlated with utility scores of the 6 health states, allowing for conversion of the GO-QOL scores to utility scores. A positive (improved) 0.013 utility change was found for each 1-point (positive) improvement in GO-QOL score produced by teprotumumab versus placebo. ConclusionPatients with moderate-to-severe active TED health states demonstrate increasing TED severity associated with declining utility values and worsening GO-QOL scores. These results indicate that the GO-QOL scores can be used to bridge to the HSU scores for benefit quantification.

Optical coherence tomography and shear wave elastography findings in Graves ophthalmopathy.

The main feature of Graves ophthalmopathy (GO) is revealed by determining the activity and severity of the disease. We aimed to evaluate the use of imaging methods can also provide additional information about the severity of this disease. Optical coherence tomography (OCT) and shear wave elastography (SWE) findings were compared in 32 patients with mild GO group and in the healthy control group. Measuring for TSH receptor antibody (TRAb) serum level is used third-generation assay. In Graves group, optic nerve sheath diameter (ONSD) values were increased in both eyes (p < 0.001, p < 0.001). SWE measurements showed a significant increase both eye optic nerve (ON) and right eye soft tissue elasticity values in GO group (p < 0.001, p < 0.001, p < 0.001, respectively). There was a significant thinning in left temporal retinal nerve fiber layer (RNFL) thickness and left RNFL peripapillary thickness in GO group (p < 0.001, p < 0.025, respectively). There was a correlation between left eye OCT and SWE findings. Also, there was a significant difference between the median left eye ON and soft tissue elasticity results in the TRAb-positive GO group (p = 0.049, p = 0.048, respectively). SWE measurements showed a significant increase both eyes ONSD, ON and right eye soft tissue elasticity values in GO group. GO group was significant thinning in some left eye regions in OCT measurements. There was a correlation between left eye OCT and SWE findings. In addition to clinical activity score and TRAb, SWE and OCT can be used to monitor in patients with GO.

Combined glucocorticoids and cyclophosphamide in the treatment of Graves’ ophthalmopathy: a systematic review and meta-analysis

PurposeTo evaluate the efficacy and safety of combined glucocorticoids (GCs) and cyclophosphamide (CYC) treatment in Graves’ ophthalmopathy (GO).MethodsWe searched PubMed, Embase, Cochrane Library, and four Chinese databases (Chinese National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), WanFang, and SinoMed) for any published randomized controlled trials (RCTs) produced from inception to December 1, 2023. Articles obtained using appropriate keywords were selected independently by two reviewers according to the established inclusion and exclusion criteria.FindingsWe retrieved 1120 records which were eventually reduced to 13 RCTs which were then included in this evaluation. Pooled results indicated that the experimental group (CYC/GCs) showed a higher response rate than control group (GCs or negative control) (RR 1.27; 95% confidence interval 1.19 to 1.37). The subgroup analysis showed that the difference in response rates among treatment protocols (CYC/P, CYC/MPS, CYC/DEX) was not statistically significant (p = 0.23).ImplicationsThe combination of GCs and CYC could be recommended as a therapeutic option for GO, especially in patients who experience recurrence after a withdrawal GCs, have a poor response to GCs, or cannot obtain monoclonal antibody agents for various reasons.

Long-term outcomes of inferomedial orbital wall decompression in Graves' ophthalmopathy in an Asian population: A 30-year retrospective study.

This study aims to evaluate the long-term outcomes of inferomedial orbital wall decompression (IMOD) in Graves' ophthalmopathy (GO). A retrospective review of 422 eyes of 226 patients with GO-related cosmetically disfiguring proptosis (COS), dysthyroid optic neuropathy (DON), or exposure keratopathy (EXP) who received IMOD from 1989 to 2020 was conducted. Hertel value (HE) and corrected visual acuity (CVA) were evaluated at baseline and regularly thereafter. Proptosis recurrence, diplopia, and adjuvant surgeries were assessed. Complete success was defined as proptosis reduction over 2 mm without recurrence and improved diplopia. Partial success was defined as proptosis reduction without recurrence but with persistent or new-onset diplopia, and failure as proptosis recurrence. After follow-up for 40.1 ± 39.6 months (range, 6-239 months), 236 eyes (55.9%) achieved complete success, 175 eyes (41.5%) achieved partial success, and 11 eyes (2.6%) had failure. Significant CVA improvement was observed in both DON and COS groups (P < 0.001 and P = 0.045, respectively). Average proptosis reduction was 5.2 ± 2.2 mm, with a significant increase of 0.5 mm after long-term follow-up (P < 0.001). Incidence of proptosis recurrence was 2.6%. Surgical success rate of COS group was positively correlated with preoperative HE. IMOD demonstrated excellent success rate in all three subgroups with a low proptosis recurrence rate and improved visual outcome in both DON and COS groups. Delayed proptosis reduction effect of IMOD may result in delayed-onset asymmetry, especially in the unilateral group.

A comparison of cardiovascular disease, cancer, mortality, and Graves' ophthalmopathy following treatment for hyperthyroidism: A Bayesian network meta-analysis.

This network meta-analysis aimed to evaluate the association of anti-thyroid drugs (ATD), radioactive iodine (RAI), and thyroidectomy with subsequent outcomes in patients with newly-diagnosed hyperthyroidism. The Ovid Medline, Ovid Embase, and Cochrane Library databases were searched for observational studies and randomized controlled trials. Included studies were published on or before 1st May 2022 involving at least two of the treatments among ATD, RAI, and thyroidectomy for hyperthyroidism. Pairwise comparisons and Bayesian network meta-analysis were used to estimate hazard ratios (HRs) and their credible interval (CrI) of outcomes, including cardiovascular disease (CVD), cancer, overall mortality, and Graves' ophthalmopathy (GO). A total of 22 cohort studies with 131,297 hyperthyroidism patients were included. Thyroidectomy was associated with lower risks of mortality and GO than ATD (HR=0.54, 95% CrI: 0.31, 0.96; HR=0.31, 95% CrI: 0.12, 0.64) and RAI (HR=0.62, 95% CrI: 0.41, 0.95; HR=0.18, 95% CrI: 0.07, 0.35). RAI had a higher risk of GO (HR=1.70, 95% CrI: 1.02, 2.99) than ATD treatment. This Bayesian network meta-analysis indicated that thyroidectomy was associated with lower risks of mortality and GO in newly-diagnosed hyperthyroid patients compared to ATD and RAI. Relative to ATD, RAI therapy increased the risk of GO.

P-65 A case of relapse of Graves ophthalmopathy due to an ophthalmic herpes zoster infection in a thyroidectomized patient with multiple comorbidities

Abstract Introduction Graves ophthalmopathy usually occurs in patients with hyperthyroidism or a history of Graves disease, but it can appear in euthyroid patients or patients with chronic thyroiditis also. It is a possible cause of sight-threatening eye disease. Its incidence is 16 for women and 3 cases for men, per 100 000 population but more severe in men, and it's higher among smokers. In mild forms, treatment can be local, but in severe cases and recurrences, systemic glucocorticoids are compulsory, with or without immunosuppressive drugs, surgery or radiotherapy. in recurrences. Clinical Case We present the case of a 76-year-old male, former smoker, diagnosed with Graves disease in 2017. He was treated with anti-thyroid treatment and in 2018 he was thyroidectomized. He also developed a progressive Graves ophthalmopathy from April to July 2017 with a reduced visual acuity for both eyes, conjunctival erythema, palpebral edema and erythema. He received methyl-prednisolone (MP) pulse therapy 6×125 mg weekly with favorable outcome. In 2019, he underwent a recession of internal rectus and inferior rectus for both eyes to correct a divergent strabism and his eye-sight improved. He presents now for an aggravation of the ophthalmopathy after an episode of a herpes zoster infection affecting the ophthalmic branch of the trigeminal nerve. He also suffers from heart failure NYHA III, permanent atrial fibrillation, large aortic stenosis, asymptomatic hyperuricemia, secondary pulmonary hypertension and chronic kidney disease stage IIIb. His medical history revealed hypercholesterolemia, hyperuricemia, heart failure, insufficient status of vitamin D3 and confirmed the chronic kidney disease stage IIIb; normal thyroid function but with high anti TSH receptor antibodies (TRAb=18.37 U/L). Given the age and the comorbidities but also the high activity of the Graves disease and the orbital CT that revealinged a great hypertrophy of the ocular muscles, our ophthalmologist suggested methyl-prednisolone pulse therapy in a standard regimen, but our cardiologist contradicted it because of the heart conditions. As the patient's left eye sight was only 2% and for the right one 20%, we decided to adapt the doses of the pulse therapy and closely monitor the patient. The first dose was 125mg MP, after that 7 doses of 250mg MP weekly was followed by 3 doses of 125mg MP weekly. After a total of 2250 mg MP at a 3 months follow-up, the patients’ eyesight improved to 60% on the left eye and 75% on the right eye and a lower level of TRAb=5.59 UI/L. Conclusion Even in patients with comorbidities where corticosteroid therapy may be detrimental, there is a possibility to adapt the doses in a safe way and with a continuous clinical monitoring so that the patients’ eyesight can be saved, therefore increasing the quality of life.

Computed tomography and magnetic resonance imaging approaches to Graves' ophthalmopathy: a narrative review.

Graves' ophthalmopathy (GO) affects up to 50% of patients with Graves' disease (GD) ranging from mild ocular irritation to vision loss. The initial diagnosis is based on clinical findings and laboratory tests. Orbital imaging, such as magnetic resonance imaging (MRI) and computed tomography (CT), is an important tool to assess orbital changes, being also useful for understanding disease progression and surgical planning. In this narrative review, we included 92 studies published from 1979 to 2020 that used either MRI and/or CT to diagnose and investigate GO, proposing new methods and techniques. Most of the methods used still need to be corroborated and validated, and, despite the different methods and approaches for thyroid eye disease (TED) evaluation, there is still a lack of standardization of measurements and outcome reports; therefore, additional studies should be performed to include these methods in clinical practice, facilitating the diagnosis and approach for the treatment of TED.

Risk of non-thyroidal autoimmune diseases in patients with Graves' disease: a nationwide retrospective cohort study.

Graves' disease (GD) is a major autoimmune thyroid disorder and associated with non-thyroidal autoimmune disease (NTAD). We aimed to investigate the risk of NTAD in patients with GD compared with age- and sex-matched controls and to evaluate whether the risk differs between individuals with or without Graves' ophthalmopathy (GO). This was a retrospective cohort study using data from the Korean National Health Claims database. We included 77 401 patients with GD (2,310 with GO) and 77 401 age- and sex-matched controls. Risk of NTAD were compared between the entire cohort and within the GD cohort. During a mean follow-up period of 9 years, NTAD developed in 12 341 (16.1%) patients in the GD cohort. Risk for systemic lupus erythematosus (SLE) [adjusted hazard ratio (aHR):1.15, 95% confidence interval (CI): 1.02-1.29], vitiligo (aHR: 1.24, 95% CI: 1.10-1.40), and alopecia areata (aHR: 1.11, 95% CI: 1.10-1.40) were higher in the GD cohort than in the control cohort. In the GD cohort, risk for SLE (aHR: 1.60, 95% CI: 1.11-2.33), Sjogren's syndrome (aHR: 1.89, 95% CI: 1.30-2.74), and ankylosing spondylitis (aHR: 1.53, 95% CI: 1.08-2.17) were higher in the GO group than in the non-GO group. This study demonstrated an increased risk of SLE, vitiligo and alopecia areata in patient with GD. In the GD cohort, patients with GO had an increased risk of SLE, Sjogren's syndrome and ankylosing spondylitis. These findings suggest that importance of implementing a strategy for early detection of NTAD based on the presence of GO.

Graves Eye Disease Medical and Surgical Management: A Review

Graves’ disease (GD) is the most frequent cause of hyperthyroidism, where iodine levels are abundant. One of the extrathyroidal symptoms is Graves’ ophthalmopathy (GO) which presents with ophthalmic symptoms that can range from minor (e.g., dry eye) to sight-threatening (e.g., corneal ulceration and compressive optic neuropathy) features. About 79% of Graves’ disease cases can be attributed to genetic predispositions, while the remaining 21% are due to environmental factors. Acute stress, active or passive smoking, and past radioactive iodine therapy have all been linked to the development or aggravation of thyroid eye disease (TED). The devastating effects of GO or TED might include diplopia, ocular hypertension, optic nerve degeneration, and glaucoma. A low basal serum Thyroid Stimulating hormone (TSH) level has the highest sensitivity and specificity for diagnosing hyperthyroidism. Moreover, the appearance of Thyroid Stimulating hormone receptors (TSHR) autoantibodies (TRAbs) is presumed to be highly specific for the diagnosis of Graves’ disease. Imaging studies of the orbit that use ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI), for example, can confirm the diagnosis of TED. In order to treat Graves’s eye disease optimally, a multidisciplinary approach must be applied involving primary care physicians, ophthalmologists, internists and endocrinologists. Therefore, it is essential to restore the euthyroid state and this can be obtained by either antithyroid medications, radioactive iodine or surgical thyroidectomy. Treatment of GO ranges from supportive treatment (lubricants and moisturizer drops), to medical intervention, preferably corticosteroid, and variable surgical interventions. Key words: Graves’ disease, Medical and surgical management

Retracted: Changes of Volume Parameters in the Treatment of Graves Ophthalmopathy by Endoscopic Transethmoidal Decompression of the Orbital Inner Wall Combined with Fat Decompression.

[This retracts the article DOI: 10.1155/2022/8149247.].

Current and promising therapies based on the pathogenesis of Graves' ophthalmopathy.

Graves' ophthalmopathy (GO) is a hyperthyroidism-related and immune-mediated disease that poses a significant threat to human health. The pathogenesis of GO primarily involves T cells, B cells, and fibroblasts, suggesting a pivotal role for the thyrotropin-antibody-immunocyte-fibroblast axis. Traditional treatment approaches for Graves' disease (GD) or GO encompass antithyroid drugs (ATDs), radioactive iodine, and beta-blockers. However, despite decades of treatment, there has been limited improvement in the global incidence of GO. In recent years, promising therapies, including immunotherapy, have emerged as leading contenders, demonstrating substantial benefits in clinical trials by inhibiting the activation of immune cells like Th1 and B cells. Furthermore, the impact of diet, gut microbiota, and metabolites on GO regulation has been recognized, suggesting the potential of non-pharmaceutical interventions. Moreover, as traditional Chinese medicine (TCM) components have been extensively explored and have shown effective results in treating autoimmune diseases, remarkable progress has been achieved in managing GO with TCM. In this review, we elucidate the pathogenesis of GO, summarize current and prospective therapies for GO, and delve into the mechanisms and prospects of TCM in its treatment.

Concurrent Myasthenia gravis (MG) and Graves' ophthalmopathy (GO)

Concurrent Myasthenia gravis (MG) and Graves' ophthalmopathy (GO)