The Clinical Phenotype of Thyroid-Associated Orbitopathy related to Underlying Thyroid Status

PURPOSE: Thyroid-Associated Orbitopathy (TAO) presents with highly variable clinical characteristics. We hypothesize that the underlying thyroid status predisposes a patient to different clinical characteristics of TAO. METHODS: We retrospectively studied the clinical data of 385 patients from the New York area who were referred to our clinic and diagnosed with TAO from Jan 1990 to Dec 2000. We divided the 385 patients into three groups: Graves' hyperthyroid, euthyroid, and hypothyroid, and analyzed them statistically. RESULTS: Three hundred thirty-one (86%) patients were hyperthyroid, 25 (6.5%) were euthyroid, and 29 (7.5%) were hypothyroid. The average age of TAO presentation in each group was 46.7, 46.1, and 49.9 years, respectively. The female-male ratio in each group was 5.25, 3.17, 13.5:1, respectively (p>0.05). The average time from thyroid disease to TAO in the hyperthyroid and hypothyroid groups was 16.6 and 38 months, respectively (p<0.05). The hyperthyroid group had more proptosis (76.1 vs. 41.4%, p=0.0001<0.05) than the hypothyroid group. CONCLUSIONS: TAO has different clinical characteristics depending on thyroid status. The hyperthyroid group has a short disease interval and more severe clinical course of TAO than the hypothyroid group.

Thyroid Associated Orbitopathy following Periocular Surgery

PURPOSE: To descirbe a series of patients in which Thyroid Associated Orbitopathy (TAO) occurred after periocular surgery. METHODS: A retrospective case review of patients who developed TAO in close temporal association with periocular surgical interventions and presented at the orbital clinic from 1997 to 2004. History of previous thyroid abnormality and the lack of TAO signs and symptoms before surgery were reviewed and analyzed. RESULTS: Nine patients that developed TAO in association with periocular surgery were identified. All were women with an average age of 59.3years. (range: 45-75 years). The patients divided into two groups. Group 1 consisted of four patients who had previously been diagnosed with Graves' hyperthyroidism (GH). They ranged in age from 48 to 75 years (average: 58.8 years). The diagnosis of GH had been made an average of 50.5 months (range: 12-96 months) before presentation with TAO. Group 2 consisted of five patients who had no previous history of thyroid abnormality. They ranged in age from 45 to 74 years (average: 60.2 years). No patients had any signs or symptoms of TAO before their recent presentation. CONCLUSIONS: Periocular surgery may lead to local inflammatory events that may contribute to the instigation of TAO in predisposed individuals.

The Epidemiologic and Clinical Characteristics of Thyroid-Associated Orbitopathy

PURPOSE: To determine the epidemiologic and clinical characteristics of thyroid-associated orbitopathy (TAO). METHODS: We retrospectively studied the clinical data of 385 patients from the New York City area diagnosed with TAO from January 1990 to December 2000. The total cases were divided into male and female groups and age-adjusted relative incidence rates were obtained to plot the incidence curve and clinical characteristics. Statistical analysis was applied to the collected data. RESULTS: The average age of patients with TAO was 46.3 years for females and 50.1 years for males. The female-male ratio was 5.31:1. In 23.3% of patients, the diagnosis of TAO was made simultaneously with their thyroid disease. In 75% of cases, the diagnosis was made within 18 months of the presentation of thyroid disease. Soft tissue involvement was noted most frequently in 311 (80.8%), eyelid retraction in 306 (79.5%), proptosis in 278 (72.2%), restrictive myopathy in 234 (60.8%), and compressive optic neuropathy in 43 (11.2%) of 385 patients. CONCLUSIONS: TAO has variable and different epidemiologic and clinical characteristics according to sex and age.

The Risk Factors for Severe Thyroid-Associated Orbitopathy

PURPOSE: To determine risk factors for severe Thyroid-Associated Orbitopathy (TAO). METHODS: We retrospectively studied the clinical data of 385 patients of the New York City area diagnosed with TAO from January 1990 to December 2000. We reviewed clinical characteristics and tried to identify several risk factors. The statistical analysis was applied to the collected data. RESULTS: Men more frequently had proptosis, restrictive myopathy, and optic neuropathy than women. Patients older than 50 years presented more frequently with proptosis, restrictive myopathy, and optic neuropathy than younger than 50 years. Patients with a family history of thyroid disease had similar clinical characteristics compare to those without family history. Smokers more often had proptosis, restrictive myopathy, and compressive optic neuropathy than nonsmokers. Patients who had received radioactive iodine (RAI) treatment were older, and were more frequently smokers. If patients were smokers and treated with radioactive iodine treatment, they were more likely to have proptosis, restrictive myopathy, and compressive optic neuropathy than if not treated with radioactive iodine. However, the RAI treatment did not seem to be associated with severe characteristics of TAO in non-smokers. CONCLUSIONS: The risk factors for severe TAO are: male, age older than 50, smoking, treated with RAI in smokers.