Prevalence and Risk Factors for Thyroid Eye Disease among Korean Dysthyroid Patients

PURPOSE: To determine the prevalence of thyroid eye disease among dysthyroid Korean patients and to analyze the relationship between demographic data, lifestyle risk factors, and status of thyroid disease and thyroid eye disease. METHODS: All dysthyroid patients who visited endocrinology clinics in 24 general hospitals in Korea during a chosen one-week period were enrolled in this cross-sectional study. Data were collected during an interviewer-administered questionnaire and chart review. Demographic data, lifestyle risk factors, and status of thyroid disease variables were analyzed as risk factors using multivariable regression models to identify independent associations with thyroid eye disease. RESULTS: A total of 1,632 dysthyroid patients were included (1,301 females [79.7%] and 331 males [20.3%]). Two hundred eighty-three of these patients (17.3%) had thyroid eye disease. Multiple logistic regression analyses revealed that female gender, young age, Graves' disease, dermopathy, anti-thyroid medication treatment, and radioiodine treatment were independent risk factors for thyroid eye disease. CONCLUSIONS: The lower prevalence of thyroid eye disease in dysthyroid Korean patients and the influence of gender on risk factors in this study are novel findings compared to studies performed involving Europeans. Although the risk factors for thyroid eye disease are understood in part, a more in-depth comparative study of gender and ethnic groups is needed to fully understand the biological significance of the demographic factors.

Bilateral versus unilateral thyroid eye disease.

Aims: The aim of this study was to compare demographics, clinical manifestations, associated systemic and ocular factors, severity and activity of patients with unilateral thyroid eye disease (U-TED) versus bilateral thyroid eye disease (B-TED). Materials and Methods: In a cross-sectional study, all patients with Graves’ hyperthyroidism and primary hypothyroidism seen in an endocrinology clinic were included from September 2003 to July 2006. Demographics, complete eye examination, severity score (NOSPECS, total eye score), and clinical activity score were recorded and compared in the B-TED and U-TED groups of patients. Results: From 851 patients with thyroid disorders, 303 (35.6%) had TED. Thirty-two patients (32/ 303, 10.56%) were found to have U-TED. Patients with U-TED (mean age 31.6 ± 11.6 years) were significantly younger than patients with B-TED (mean age 37.7 ± 14.7 years). Monovariate analysis (Chi-square and independent sample t-test) showed a significantly higher severity score in B-TED (U-TED 4.09±4.05, B-TED: 6.7±6.3; P= 0.002) and more activity score in B-TED (U-TED= 1.03±0.96, B-TED: 1.74±1.6, P= 0.001). However, multivariate analysis did not show any significant difference between the two groups in terms of age, gender, type of thyroid disease, duration of thyroid disease and TED, severity and activity of TED, smoking habit, and presentation of TED before or after the presentation of thyroid disease (0.1<P<1). Conclusion: This study did not find any significant difference between U-TED and B-TED in relation to the demographics, type of thyroid disease, associated findings, and severity and activity of TED.

Risk Factors Associated with the Severity of Thyroid-Associated Orbitopathy in Korean Patients

PURPOSE: The purpose of this study is to identify risk factors for severe thyroid-associated orbitopathy (TAO) and compressive optic neuropathy in Korean patients. METHODS: This study was a retrospective comparative case series. All TAO patients who were first seen at our institution between 2005 and 2009 and who had follow-up periods of at least 6 months were included. Patients were divided into mild or moderate and severe TAO groups. Cases were also segregated based on the presence or absence of optic neuropathy. Demographics, smoking status, comorbidities, thyroid hormonal status, thyroid autoantibody levels, and clinical presentations were assessed. RESULTS: A total of 99 patients (83 with mild to moderate courses and 16 with severe courses; 90 without optic neuropathy and 9 with optic neuropathy) were included in this study. On multiple logistic regression analysis, smoking status was a predictive risk factor for a severe course of TAO and the development of optic neuropathy (odds ratios = 6.57 and 10.00, respectively). Other factors such as age, gender, free T4 level, thyroid binding-inhibiting immunoglobulin, and a history of diabetes were not predictive of severe TAO or optic neuropathy. CONCLUSIONS: Although various factors may influence the severity of TAO and the development of optic neuropathy, this study showed that smoking was a risk factor for severe TAO and the development of optic neuropathy. Therefore, it is important for patients with Graves' disease to refrain from smoking. Frequent and careful observation should also be performed in current smokers, as TAO patients who smoke are susceptible to a severe course and/or optic neuropathy.

Estrabismo en orbitopatía / Strabismus in orbitopathy

Introducción: la fibrosis y contractura muscular determina la aparición de un estrabismo restrictivo. Objetivo: describir aspectos clínicos-radiológicos y resultados quirúrgicos en una serie de pacientes. Materiales y métodos: estudio retrospectivo de 22 pacientes operados en 2 centros clínicos entre 1990 y 2005 con tabulación de datos clínicos, mediciones en 9 posiciones, ducciones, resultados quirúrgicos y complicaciones. Además análisis doble-ciego clínico radiológico. Resultados: mayor prevalencia en mujeres (88 por ciento), (x) edad 57 años, síntoma inicial diplopia (100 por ciento). Compromiso muscular RI (72 por ciento), RM (63 por ciento), RS (22 por ciento), RL (9 por ciento). Grupos más frecuentes: RM bilateral (18.2 por ciento) y RI unilateral (16 por ciento). Resultado postoperatorio excelente (sin diplopia) 75 por ciento, satisfactorio (sin diplopia con prismas) 23 por ciento y malo (diplopia permanente) 2 por ciento. Correlación clínico-radiológica exacta (45 por ciento) y del principal músculo afectado (100 por ciento. Complicaciones: 33 por ciento ptosis palpebral inferior y 9.5 por ciento neuropatía óptica compresiva. Conclusión: el manejo estrabológico adecuado en orbitopatía de graves otorga en un alto porcentaje una mejoría de sus síntomas y mejor calidad de vida.

Introduction: fibrosis and muscular contracture results in restrictive strabismus. Objective: describe clinical-radiological features and surgery results in a group of patients. Methodology: retrospective study of 22 surgical patients treated in 2 ophthalmology institutes between 1990 and 2005. Ciinical data, 9 positions and duction study, surgical results and finally incidence of complications were all assesed. Also a double-blind clinical-radiological correlation was performed. Results: female were more affected (88 percent), mean age 57 years, initial sympton was diplopia en every case. Muscle involvement IR (72 percent), MR (63 percent), SR (22 percent), LR (9 percent). Most frequently muscle associations: both MRs (18.2 percent) and unilateral IR (16 percent). Postoperative results: excellent (diplopia free) 75 percent, satisfactory (diplopia corrected with prisms) 23 percent, bad (persistent diplopia) 2 percent. Exact clinical-radiological correlation (45 percent), mayor affected muscles correlation (100 percent). Complications: inferior palpebral ptosis (33 percent) and comprenssive optic neuropathy. Conclusions: adequate strabismus management in graves orbithopathy gives the patient symptomatic relief and better life quality in a high percentage of cases.