RESUMO
Diffuse toxic goiter (DTG) is an autoimmune disease caused by antibodies against thyroid-stimulating hormone (TSH) receptors. Combinations of DTG with other autoimmune diseases such as endocrine ophthalmopathy, pretibial myxedema and acropathy are often observed in clinical practice. Along with this pathology, the patient has hypodynamia and, as a result, the development of functional disorders of the musculoskeletal system. Aim - to analyze the comprehensive clinical observation of the diagnosis and treatment of DTZ with EOP of a child aged 15 years. Material and methods. Analysis of medical history data, comprehensive examination, including fixation of the physiological and dental status, supervision of patient K., 15 years old, who was on inpatient treatment in the children's department of the State Medical Institution "OKB No. 1" in Tyumen. Conclusion. This case report demonstrates symptoms of diffuse toxic goiter with ophthalmopathy that may manifest on only one side. It shows a decrease in functional parameters, manifestations in the dental system, due to a decrease in habitual motor activity, which corresponds to the clinical picture of manifestations of periodontal disease. In addition, it shows the possibility of relapse of the disease after clinical and laboratory remission during medication intake, what may be an indication for surgical treatment. Practitioners need to remember about this pathology and the need for its timely diagnosis, including specialists in related fields.
Assuntos
Oftalmopatia de Graves , Humanos , Adolescente , Oftalmopatia de Graves/diagnóstico , Feminino , Masculino , Bócio/tratamento farmacológico , Bócio/patologia , Bócio/diagnósticoRESUMO
A 40-year-old African-American man was referred to our dermatology clinic for management of his long-standing thyroid dermopathy. The patient was diagnosed with hyperthyroidism at the age of 20, and was treated with radioactive iodine I-131 but subsequently lost to follow-up. He had not consulted physicians again until the age of 30. Then he presented with severe thyroid eye disease, significant weight gain, hypothy-roidism, and painful leg swelling. Levothyroxine was initiated, which stabilized his thyroid levels but had no effect on his exophthalmos and leg swelling.
Assuntos
Oftalmopatia de Graves , Humanos , Masculino , Adulto , Oftalmopatia de Graves/diagnóstico , Hipertireoidismo/diagnóstico , Hipertireoidismo/complicaçõesRESUMO
BACKGROUND: The first line treatment for moderate to severe active thyroid associated ophthalmopathy is glucocorticoid pulse therapy, but for patients with contraindications to hormone therapy or hormone resistance, it is urgent to find a suitable treatment plan. AIMS: To find a reliable alternative to hormone pulse therapy for thyroid associated ophthalmopathy by comparing the efficacy with first-line treatment regimens. METHODS: Search PubMed, Ovid, Web of science, Cochrane library, and Clinical Trials.gov for randomized controlled trials on the treatment of thyroid associated ophthalmopathy published as of July 7, 2024. Quality evaluation and Bayesian network analysis were conducted using RevMan 5.3 software, STATA15.0 software, and ADDIS 1.16.8 software. RESULTS: A total of 666 patients were included in 11 studies and 8 interventions. Network analysis showed that the three interventions of mycophenolate mofetil combined with glucocorticoids, Teprotumumab and 99Tc-MDP were superior to glucocorticoid pulse therapy in improving clinical activity scores and proptosis. The regimen of glucocorticoids combined with statins can improve the quality of life score and diplopia score of patients. Neither methotrexate combined with glucocorticoids nor rituximab alone showed additional advantages when compared with glucocorticoid pulse therapy. CONCLUSION: Mycophenolate mofetil combined with glucocorticoid therapy is very beneficial for moderate to severe active thyroid associated ophthalmopathy. Mycophenolate mofetil may be a good choice when patients have contraindications to hormone use or hormone resistance. Teprotumumab is very promising and may be able to avoid patients undergoing orbital decompression surgery. The durability and safety of its long-term efficacy need to be further observed.
Assuntos
Teorema de Bayes , Glucocorticoides , Oftalmopatia de Graves , Humanos , Oftalmopatia de Graves/tratamento farmacológico , Oftalmopatia de Graves/diagnóstico , Glucocorticoides/uso terapêutico , Glucocorticoides/administração & dosagem , Metanálise em Rede , Qualidade de Vida , Anticorpos Monoclonais HumanizadosRESUMO
PURPOSE: To evaluate the evidence for alterations of blood flow, vascular and perfusion densities in the choroid, macula, peripapillary region, and the area surrounding the optic nerve head (ONH) in patients with thyroid-associated ophthalmopathy (TAO) based on changes of OCTA parameters. METHODS: A systematic review of Pubmed, Google Scholar, Scopus, WOS, Cochrane, and Embase databases, including quality assessment of published studies, investigating the alterations of OCTA parameters in TAO patients was conducted. The outcomes of interest comprised changes of perfusion and vascular densities in radial peripapillary capillary (RPC), ONH, superficial and deep retinal layers (SRL and DRL), choriocapillaris (CC) flow, and the extent of the foveal avascular zone (FAZ). RESULTS: From the total of 1253 articles obtained from the databases, the pool of papers was narrowed down to studies published until March 20th, 2024. Lastly, 42 studies were taken into consideration which contained the data regarding the alterations of OCTA parameters including choriocapillary vascular flow, vascular and perfusion densities of retinal microvasculature, SRL, and DRL, changes in macular all grid sessions, changes of foveal, perifoveal and parafoveal densities, macular whole image vessel density (m-wiVD) and FAZ, in addition to alterations of ONH and RPC whole image vessel densities (onh-wiVD and rpc-wiVD) among TAO patients. The correlation of these parameters with visual field-associated parameters, such as Best-corrected visual acuity (BCVA), Visual field mean defect (VF-MD), axial length (AL), P100 amplitude, and latency, was also evaluated among TAO patients. CONCLUSION: The application of OCTA has proven helpful in distinguishing active and inactive TAO patients, as well as differentiation of patients with or without DON, indicating the potential promising role of some OCTA measures for early detection of TAO with high sensitivity and specificity in addition to preventing the irreversible outcomes of TAO. OCTA assessments have also been applied to evaluate the effectiveness of TAO treatment approaches, including systemic corticosteroid therapy and surgical decompression.
Assuntos
Angiofluoresceinografia , Oftalmopatia de Graves , Vasos Retinianos , Tomografia de Coerência Óptica , Humanos , Oftalmopatia de Graves/fisiopatologia , Oftalmopatia de Graves/diagnóstico por imagem , Oftalmopatia de Graves/diagnóstico , Tomografia de Coerência Óptica/métodos , Angiofluoresceinografia/métodos , Vasos Retinianos/diagnóstico por imagem , Vasos Retinianos/fisiopatologia , Corioide/irrigação sanguínea , Corioide/diagnóstico por imagem , Disco Óptico/irrigação sanguínea , Disco Óptico/diagnóstico por imagem , Macula Lutea/diagnóstico por imagem , Macula Lutea/irrigação sanguínea , Fundo de Olho , Fluxo Sanguíneo Regional/fisiologia , Acuidade Visual/fisiologiaRESUMO
The authors describe a case of bilateral diffuse paraneoplastic orbital myositis induced by a stage IA left testicular pure seminoma. The patient presented with findings typical of thyroid-associated orbitopathy (TAO) and was thought to have TAO until discovery of the malignancy. Treatment included an urgent orchiectomy, as well as 7 weeks of therapeutic plasma exchange. This is the fifth reported case of seminoma-associated orbitopathy, and the second to occur while cancer was in the occult phase. Although seminoma-associated orbitopathy is exceedingly rare, it can masquerade as TAO and should be considered in the differential diagnosis of any young male with atypical TAO findings.
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Oftalmopatia de Graves , Orquiectomia , Seminoma , Neoplasias Testiculares , Humanos , Masculino , Seminoma/diagnóstico , Seminoma/cirurgia , Diagnóstico Diferencial , Neoplasias Testiculares/diagnóstico , Oftalmopatia de Graves/diagnóstico , Tomografia Computadorizada por Raios X , Adulto , Imageamento por Ressonância Magnética , Miosite Orbital/diagnóstico , Miosite Orbital/tratamento farmacológico , Síndromes Paraneoplásicas Oculares/diagnósticoRESUMO
Elevated immunoglobulin G4 (IgG4) serum antibodies are an important feature of IgG4-related disease. However, IgG4 antibodies can play a role in autoimmune thyroid disorders. In this study, we aimed to evaluate the impact of serum IgG4 levels on clinical features of Graves' disease (GD). We recruited 60 patients with GD (48 patients without thyroid eye disease, 12 patients with moderate-to-severe Graves' orbitopathy [GO], and 25 healthy control subjects). The prevalence of high IgG4 serum concentration was 4.2% among GD patients without GO and 33.33% in patients with moderate-to-severe GO. The group with GO had significantly higher median IgG4 levels (87.9 mg/dL) than the control group (41.2 mg/dL, P = 0.034) and the GD without GO group (30.75 mg/dL, P < 0.001). Patients with thyroid nodules had lower IgG4 levels than patients without thyroid nodules, but the difference was not statistically significant (35.7 [24.8; 41.53] mg/dL vs. 43 [30.1; 92.7] mg/dL, P = 0.064). IgG4 as a diagnostic tool for moderate-to-severe GO had the following parameters: area under the curve (AUC): 0.851 (P < 0.001), at the cut-off value of 49 mg/dL, negative predictive value: 100%, positive predictive value: 48%, sensitivity: 100%, specificity: 73%. There were no significant differences between the high and normal IgG4 groups in thyroid hormones, antithyroid antibodies, and ultrasound features. Serum IgG4 levels are associated with some of the clinical features of GD and can help in the diagnostic process of the disease. More research is needed to better understand the pathophysiology of IgG4 involvement in GD.
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Doença de Graves , Oftalmopatia de Graves , Imunoglobulina G , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Masculino , Feminino , Doença de Graves/sangue , Doença de Graves/diagnóstico , Doença de Graves/imunologia , Pessoa de Meia-Idade , Adulto , Oftalmopatia de Graves/sangue , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/imunologia , Biomarcadores/sangue , Índice de Gravidade de Doença , Idoso , Sensibilidade e Especificidade , Estudos de Casos e Controles , Nódulo da Glândula Tireoide/sangue , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/imunologia , Relevância ClínicaRESUMO
PURPOSE: The aim of this study was to investigate the peripapillary choroidal vascular changes in thyroid orbitopathy (TO). METHODS: The study included 20 eyes of 10 patients with active TO (aTO), 30 eyes of 15 patients with inactive TO (inaTO) and 30 eyes of 30 healthy subjects. The peripapillary choroidal vascular change was assessed with peripapillary choroidal vascular index (pCVI), peripapillary choroidal luminal area (pLA), peripapillary choroidal stromal area (pSA), peripapillary total choroidal area (pTCA). RESULTS: Compared to the control group, there was a reduction in the nasal and temporal areas of pCVI in both the aTO and inaTO groups (aTO vs control: nasal p = 0.001 and temporal p = 0.004; inaTO vs control: nasal p = 0.007 and temporal p < 0.001), while the inferior area was lower only in the inaTO group (p = 0.001). Compared to the other groups, the inaTO group exhibited a decrease pSA (vs aTO: total p = 0.004, inferior p = 0.02 and vs control: total p = 0.01, inferior p = 0.03), pLA (vs aTO: total p = 0.02, inferior p = 0.02, temporal p < 0.001 and vs control: total p = 0.002, inferior p < 0.001, temporal p < 0.001) and pTCA (vs aTO: total p = 0.009, inferior p = 0.01, temporal p < 0.001 and vs control: total p = 0.003, inferior p = 0.001, temporal p < 0.001). CONCLUSION: The horizontal area (nasal and temporal area) of the peripapillary choroidal vascular structure may be more sensitive than the vertical area in TO patients. The first affected quadrant of RPC-VD in the active TO may be the inferior quadrant. Structural or vascular choroidal changes may occur during the chronic or post-active phase of the disease.
Assuntos
Corioide , Oftalmopatia de Graves , Disco Óptico , Tomografia de Coerência Óptica , Humanos , Corioide/irrigação sanguínea , Corioide/patologia , Corioide/diagnóstico por imagem , Masculino , Feminino , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/patologia , Pessoa de Meia-Idade , Tomografia de Coerência Óptica/métodos , Adulto , Disco Óptico/irrigação sanguínea , Disco Óptico/patologia , Vasos Retinianos/patologia , Vasos Retinianos/diagnóstico por imagem , Acuidade Visual , Angiofluoresceinografia/métodosRESUMO
BACKGROUND: Endocrine orbitopathy (EO) is an autoimmune disease mostly associated with a disease of the thyroid gland, which leads to inflammation, adipogenesis and fibrosis. The severity of EO can vary greatly between individuals, which makes it difficult to exactly predict the natural course of the disease; however, this is important to be able to individually adapt the treatment. The aim of this study was to compare the clinical features, course, treatment and prognosis for patients with EO under 50 years old with older patients. The results of the study with a focus on motility are presented in this special issue. PATIENTS AND METHODS: The hospital records of a randomly selected sample of 1000 patients from the EO databank in Essen (GODE), which includes 4260 patients, were analyzed. The patients were divided into two groups: group 1 ≤50 years and group 2 >50 years. Only patients with complete data sets were included in the statistical analyses. RESULTS: Younger patients (nâ¯= 484) presented significantly more frequently with milder EO (53% vs. 33%, pâ¯< 0.0001), whereas older patients (nâ¯= 448) more frequently suffered from moderate or severe forms (44% vs. 64%, pâ¯< 0.0001). Older patients showed more severe strabismus, motility and clinical activity scores (5.9 vs. 2.3 prism diopters, PD/310° vs. 330°, both pâ¯< 0.0001, CAS 2.1 vs. 1.7, pâ¯= 0.001). Proptosis and the occurrence of optic nerve compression showed no significant differences between the groups (3% each). Multiple logistic regression showed that the necessity for a second eye muscle surgery was most strongly associated with a previous decompression (ORâ¯= 0.12, 95â¯% CI 0.1-0.2, pâ¯< 0.0001), followed by orbital irradiation and age. CONCLUSION: In summary, younger patients with EO presented with milder clinical features, such as a lower rate of restrictive motility disorders and weaker expression of signs of inflammation. Therefore, older patients needed steroids, irradiation, eyelid and eye muscle surgery more frequently; however, the risk of dysthyroid optic neuropathy and the necessity of a second eye surgery were not or only slightly associated with age.
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Diplopia , Oftalmopatia de Graves , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diplopia/etiologia , Diplopia/epidemiologia , Oftalmopatia de Graves/complicações , Oftalmopatia de Graves/epidemiologia , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/terapia , Prognóstico , Fatores de RiscoRESUMO
Background: The current clinical practice lacks sufficient objective indicators for evaluating thyroid-associated ophthalmopathy (TAO). This study aims to quantitatively assess TAO by evaluating levator palpebrae superioris (LPS) using Dixon-T2WI. Methods: The retrospective study included 231 eyes (119 patients) in the TAO group and 78 eyes (39 volunteers) in the normal group. Dixon-T2WI provided data on maximum thickness of LPS (LPS_T) and signal intensity ratio (LPS_SIR) between the muscle and ipsilateral brain white matter. TAO diagnosis and assessment of its activity and severity were quantitatively determined using LPS_T and LPS_SIR. Results: In the TAO group, LPS_T and LPS_SIR were higher than those in the normal group (p < 2.2e-16). The upper lid retraction (ULR) ≥ 2 mm group exhibited higher LPS_T and LPS_SIR compared to the ULR < 2 mm and normal groups. Optimal diagnostic performance was achieved with an AUC of 0.91 for LPS_T (cutoff: 1.505 mm) and 0.81 for LPS_SIR (cutoff: 1.170). LPS_T (p = 2.8e-07) and LPS_SIR (p = 3.9e-12) in the active phase were higher than in the inactive phase. LPS_T and LPS_SIR showed differences among the mild, moderate-to-severe, and sight-threatening groups (p < 0.05). ROC showed an AUC of 0.70 for LPS_T (cutoff: 2.095 mm) in judging the active phase, and 0.78 for LPS_SIR (cutoff: 1.129). For judging the moderate-to-severe and above, AUC was 0.76 for LPS_T (cutoff: 2.095 mm) and 0.78 for LPS_SIR (cutoff: 1.197). Conclusion: The maximum thickness and SIR of LPS provide imaging indicators for assisting in the diagnosis and quantitative evaluation of TAO.
Assuntos
Oftalmopatia de Graves , Imageamento por Ressonância Magnética , Músculos Oculomotores , Humanos , Oftalmopatia de Graves/diagnóstico , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Músculos Oculomotores/patologia , Músculos Oculomotores/fisiopatologia , Imageamento por Ressonância Magnética/métodos , Idoso , Pálpebras/patologia , Estudos de Casos e ControlesRESUMO
PURPOSE: Strabismus reoperation in Graves' ophthalmopathy (GO) is complicated and challenging. The purpose of this study was to evaluate the various surgical strategies of strabismus reoperation and their outcomes in patients with GO. METHODS: A retrospective study was conducted on strabismus reoperations performed at the Zhongshan Ophthalmic Center of Sun Yat-sen University, Guangzhou, China from 2008 to 2018. Data collected included sex, age at surgery, duration of deviation, ocular alignment, ocular motility, various surgical procedures performed and surgical outcomes. Surgical methods included rectus recession for newly developed strabismus, rectus resection for undercorrection and anterior advancement of a previously recessed rectus for overcorrection. Surgical success was defined as an absence of diplopia, a horizontal deviation of ≤ 10 prism diopters (PD) and a vertical deviation of ≤ 5 PD at distance in primary and reading positions. RESULTS: Of the 153 GO patients receiving strabismus surgery, 27 cases (20 males, 7 females) underwent reoperation for strabismus, with a reoperation rate of 17.6%. Success rates of reoperation in patients with a previous undercorrection and overcorrection were 45% and 71.4%, respectively. Success rates of rectus recession, rectus resection and anterior advancement were 47.1%, 66.7% and 50%, respectively. Two patients underwent the third surgery. The overall success rate was 51.9%. CONCLUSIONS: Rectus recession is an effective method for GO patients with newly-developed strabismus. Rectus resection may benefit some patients with undercorrection who underwent a maximal degree of rectus recession. Anterior advancement of a previously recessed rectus is effective for cases with overcorrection.
Assuntos
Oftalmopatia de Graves , Músculos Oculomotores , Procedimentos Cirúrgicos Oftalmológicos , Reoperação , Estrabismo , Humanos , Oftalmopatia de Graves/cirurgia , Oftalmopatia de Graves/complicações , Oftalmopatia de Graves/diagnóstico , Masculino , Estrabismo/cirurgia , Estrabismo/etiologia , Estrabismo/fisiopatologia , Feminino , Estudos Retrospectivos , Reoperação/estatística & dados numéricos , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Pessoa de Meia-Idade , Adulto , Movimentos Oculares/fisiologia , Visão Binocular/fisiologia , Idoso , Seguimentos , Resultado do Tratamento , Acuidade Visual , Adulto JovemRESUMO
PURPOSE: To investigate the relationship between the kinematics of spontaneous blinks and the anterior area of the levator palpebrae superioris muscle in patients with Graves orbitopathy (GO). METHODS: This is a case-control study. The authors measured the margin reflex distance of the upper eyelid (margin reflex distance 1), the kinematics of spontaneous blinks, and the anterior area of levator palpebrae superioris muscle in CT coronal scans of patients with Graves upper eyelid retraction (GO) and a control group. The eye with the greatest margin reflex distance 1 was selected for analysis in each group. RESULTS: A total of 68 participants were included, with 36 in the GO group and 32 in the control group. In the GO group, the mean margin reflex distance 1 measured 6.5 mm, while in the control group, it was 3.9 mm. Almost all parameters related to the closing phase of spontaneous blinking activity, including amplitude, velocity, blinking rate, and interblink time, did not differ between the two groups. However, the effectiveness of the blink's amplitude (ratio of blink amplitude to margin reflex distance 1) and the main sequence (relationship between amplitude and velocity) were significantly reduced in the GO group compared with the control group. The area of the levator palpebrae superioris muscle was significantly larger in GO than in controls, with 71.4% of patients' muscles outside of the maximum range of the controls. CONCLUSIONS: In patients with GO, there is a reduction in blinking effectiveness, also known as blink lagophthalmos, which is a factor in the common occurrence of ocular surface symptoms. The increase in velocity with amplitude is also reduced in GO.
Assuntos
Piscadela , Pálpebras , Oftalmopatia de Graves , Músculos Oculomotores , Humanos , Piscadela/fisiologia , Feminino , Oftalmopatia de Graves/fisiopatologia , Oftalmopatia de Graves/complicações , Oftalmopatia de Graves/diagnóstico , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Adulto , Estudos de Casos e Controles , Pálpebras/fisiopatologia , Doenças Palpebrais/fisiopatologia , Doenças Palpebrais/diagnóstico , Idoso , Tomografia Computadorizada por Raios X , LagoftalmiaRESUMO
PURPOSE: To find a correlation between the clinical (vision-inflammation-strabismus-appearance [VISA] score) and radiological (apparent diffusion coefficient [ADC] values) scores for evaluating disease activity in patients with thyroid-associated orbitopathy. DESIGN: A prospective comparative study. METHODS: Our study was performed for consecutively diagnosed thyroid-associated orbitopathy (TAO) patients. Clinical evaluation included the VISA classification system with the basic thyroid workup. An inflammatory score of <4/8 was considered inactive and ≥4/8 as an active disease. Every included patient underwent a diffusion-weighted magnetic resonance imaging (DW-MRI) scan of the orbits. The orbital parameters evaluated on imaging included the proptosis, thickness, as well as the ADC values of extraocular muscles. RESULTS: We studied 33 consecutive patients (23 females, 69.7%) with a mean age of 41.8 years. The majority (n = 27, 81.8%) were hyperthyroid, four were hypothyroid, and two were euthyroid. In the VISA classification, nine patients had active TAO (≥4/8 inflammation score), while 24 had inactive disease. There was a positive correlation between the inflammation score and ADC values of medial rectus (MR), inferior rectus (IR) and lateral rectus (LR). We had nine patients with inflammation scores ≥4. With receiver operating characteristic (ROC) curve analysis, we found that the ADC value of IR can predict disease activity with 68% sensitivity and MR-ADC can predict active TAO with 87% sensitivity. CONCLUSION: The ADC parameters of DW-MRI are objective and less operator dependent than the clinical TAO activity scores like VISA classification. A randomized control trial may provide robust data on this correlation.
Assuntos
Oftalmopatia de Graves , Músculos Oculomotores , Órbita , Humanos , Oftalmopatia de Graves/diagnóstico , Feminino , Estudos Prospectivos , Masculino , Adulto , Pessoa de Meia-Idade , Músculos Oculomotores/diagnóstico por imagem , Músculos Oculomotores/fisiopatologia , Órbita/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Adulto Jovem , Seguimentos , Idoso , Índice de Gravidade de DoençaRESUMO
PURPOSE: This study aimed to explore the diagnostic value of whole-orbit-based multiparametric assessment on Dixon MRI for the evaluation of the thyroid eye disease (TED) activity. METHODS: The retrospective study enrolled patients diagnosed as TED and obtained their axial and coronal Dixon MRI scans. Multiparameters were assessed, including water fraction (WF), fat fraction (FF) of extraocular muscles (EOMs), orbital fat (OF), and lacrimal gland (LG). The thickness of OF and herniation of LG were also measured. Univariable and multivariable logistic regression was applied to construct prediction models based on single or multiple structures. Receiver operating characteristic (ROC) curve analysis was also implemented. RESULTS: Univariable logistic analysis revealed significant differences in water fraction (WF) of the superior rectus (P = 0.018), fat fraction (FF) of the medial rectus (P = 0.029), WF of OF (P = 0.004), and herniation of LG (P = 0.012) between the active and inactive TED phases. Multivariable logistic analysis and corresponding receiver operating characteristic curve (ROC) analysis of each structure attained the area under the curve (AUC) values of 0.774, 0.771, and 0.729 for EOMs, OF, and LG, respectively, while the combination of the four imaging parameters generated a final AUC of 0.909. CONCLUSIONS: Dixon MRI may be used for fine multiparametric assessment of multiple orbital structures. The whole-orbit-based model improves the diagnostic performance of TED activity evaluation.
Assuntos
Oftalmopatia de Graves , Músculos Oculomotores , Órbita , Curva ROC , Humanos , Masculino , Feminino , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/diagnóstico por imagem , Estudos Retrospectivos , Pessoa de Meia-Idade , Órbita/diagnóstico por imagem , Órbita/patologia , Músculos Oculomotores/diagnóstico por imagem , Músculos Oculomotores/patologia , Adulto , Idoso , Imageamento por Ressonância Magnética Multiparamétrica/métodos , Imageamento por Ressonância Magnética/métodos , Aparelho Lacrimal/diagnóstico por imagem , Aparelho Lacrimal/patologiaRESUMO
Purpose: Thyroid eye disease (TED) is characterized by proliferation of orbital tissues and complicated by compressive optic neuropathy (CON). This study aims to utilize a deep-learning (DL)-based automated segmentation model to segment orbital muscle and fat volumes on computed tomography (CT) images and provide quantitative volumetric data and a machine learning (ML)-based classifier to distinguish between TED and TED with CON. Methods: Subjects with TED who underwent clinical evaluation and orbital CT imaging were included. Patients with clinical features of CON were classified as having severe TED, and those without were classified as having mild TED. Normal subjects were used for controls. A U-Net DL-model was used for automatic segmentation of orbital muscle and fat volumes from orbital CTs, and ensemble of Random Forest Classifiers were used for volumetric analysis of muscle and fat. Results: Two hundred eighty-one subjects were included in this study. Automatic segmentation of orbital tissues was performed. Dice coefficient was recorded to be 0.902 and 0.921 for muscle and fat volumes, respectively. Muscle volumes among normal, mild, and severe TED were found to be statistically different. A classification model utilizing volume data and limited patient data had an accuracy of 0.838 and an area under the curve (AUC) of 0.929 in predicting normal, mild TED, and severe TED. Conclusions: DL-based automated segmentation of orbital images for patients with TED was found to be accurate and efficient. An ML-based classification model using volumetrics and metadata led to high diagnostic accuracy in distinguishing TED and TED with CON. By enabling rapid and precise volumetric assessment, this may be a useful tool in future clinical studies.
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Tecido Adiposo , Aprendizado Profundo , Oftalmopatia de Graves , Músculos Oculomotores , Tomografia Computadorizada por Raios X , Humanos , Oftalmopatia de Graves/diagnóstico por imagem , Oftalmopatia de Graves/diagnóstico , Masculino , Feminino , Pessoa de Meia-Idade , Tecido Adiposo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Músculos Oculomotores/diagnóstico por imagem , Adulto , Órbita/diagnóstico por imagem , Idoso , Estudos Retrospectivos , Curva ROC , Tamanho do ÓrgãoRESUMO
Thyroid-associated ophthalmopathy (TAO), also referred to as Graves' ophthalmopathy, is a medical condition wherein ocular complications arise due to autoimmune thyroid illness. The diagnosis of TAO, reliant on imaging, typical ocular symptoms, and abnormalities in thyroid function or thyroid-associated antibodies, is generally graded and staged. In recent years, Artificial intelligence(AI), particularly deep learning(DL) technology, has gained widespread use in the diagnosis and treatment of ophthalmic diseases. This paper presents a discussion on specific studies involving AI, specifically DL, in the context of TAO, highlighting their applications in TAO diagnosis, staging, grading, and treatment decisions. Additionally, it addresses certain limitations in AI research on TAO and potential future directions for the field.
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Inteligência Artificial , Oftalmopatia de Graves , Humanos , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/terapia , Aprendizado ProfundoRESUMO
Graves' orbitopathy is a common complication of Graves' disease. The mild form dominates, whereas moderate to severe and sight threatening forms are rarer. They require quick, adequate care, involving cooperation between county hospitals and the regional hospital, and adequate diagnostics and choice of treatments of treatments. A new national guideline for hyperthyroidism has been published in Sweden in January 2023, where these aspects are highlighted. The present guideline requires implementation regionally, as all components are not in place, but reflects the needs of patients. This article highlights important aspects for patients such as information, to be listened to, accessibility and adequate care, but also defines actions necessary in primary care where patients most often seek help at first. Lastly, important medical and practical aspects are reviewed by the endocrinologist and the ophthalmologist.
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Endocrinologistas , Clínicos Gerais , Oftalmopatia de Graves , Humanos , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/terapia , Oftalmologistas , Guias de Prática Clínica como Assunto , Suécia , Educação de Pacientes como Assunto , Atenção Primária à SaúdeRESUMO
Thyroid eye disease (TED) is the most common extrathyroidal manifestation of Graves disease. There has been no effective medication to prevent proptosis in thyroid eye disease until 2020 when the anti-insulin-like growth factor 1 receptor (anti-IGF-1R) antibody, Teprotumumab, was approved by the US Food and Drug Administration, sparking increased interest in immune-based drug development. This study aims to review the newly developed drug therapy as well as conventional treatment for TED. Treatment of TED has traditionally been high-dose steroids and orbital radiotherapy, but recently there has been a paradigm shift in the treatment of TED in the United States with the introduction of the therapeutic agent teprotumumab, which dramatically reduces proptosis. However, concerns remain about the development of hearing impairment as a potentially fatal complication and long-term safety. Recently, several clinical trials are underway to assess the efficacy and safety of novel drugs targeting mammalian target of rapamycin complex 1, interleukin-6, fragment crystallizable receptor, and IGF-1R in treating TED. With the explosive increase in interest from academia and pharmaceutical companies in TED, there is anticipation for the development of drugs that are equivalent or superior to teprotumumab while being safer.
Assuntos
Oftalmopatia de Graves , Humanos , Oftalmopatia de Graves/tratamento farmacológico , Oftalmopatia de Graves/diagnóstico , Anticorpos Monoclonais HumanizadosRESUMO
Objective: The management of thyroid eye disease (TED) has undergone significant changes for decades. The study sought to investigate current clinical practice on the management of TED in China. Methods: An online questionnaire survey was conducted from April to May 2023. The questionnaire involved diagnostic criteria for TED, multidisciplinary treatment (MDT) collaboration, and treatment preference for mild, moderate, and severe TED. Results: A total of 289 questionnaires were collected, with 165 from endocrinologists and 124 from ophthalmologists. Only 36.7% of participants claimed there was an MDT clinical pattern for TED in their institutions. The coverage of biological agents was around 10% or lower. These were distinctly lower than in Western countries. About 62.6% of participants believed the incidence of TED has increased in recent years. Imaging techniques were used widely to assist in the diagnosis of TED. However, there was still controversy regarding the definition of proptosis in the Chinese population. Most doctors managed risk factors and provided orbital supportive treatments of artificial tears and glasses. For mild active TED, endocrinologists (39.4%) were inclined to recommend therapy for hyperthyroidism alone, while ophthalmologists (43.6%) preferred orbital corticosteroid injections. Currently, the most widely used treatment for moderate to severe active TED was high-dose intravenous corticosteroid (94.8%), while orbital radiotherapy combined with immunosuppressive agents was the most recognized second-line therapy (43.6%). Conclusion: The study documented the consistency and differences between current clinical practices in the management of TED in China and the recently updated guidelines. There was a remarkable difference between ophthalmology and endocrinology departments, warranting management optimization.