No abstract available.
Graves Ophthalmopathy*

A 62-year-female presented with bilateral proptosis and 1 year episodic eye pain, grittiness, redness, watering and intermittent diplopia for 6 months, and drooping of right eye lid for 2 months (Figure 1). She had a firm WHO grade-1b goiter, exopthalmos (26 mm and 23 mm in left and right eye respectively, Hertel exopthalmometer), clinical activity score of 1/6, without any evidence of bulbar, neck muscles and limb weakness.
Graves Ophthalmopathy ; Hypothyroidism

Objective: This study determined the prevalence of Graves ophthalmopathy among thyroid-disease patients at a tertiary government hospital. Methods: Patients with thyroid disease seen at a tertiary hospital from February to September 2007 were enrolled. All patients underwent ophthalmologic examination consisting of visual-acuity testing; exophthalmometry; examination for presence of lid retraction, lid lag, and lateral flare; globe position; external-ocular-muscle-movement grading; corneal light reflex; and direct funduscopic examination. All clinical findings were recorded and data were analyzed. Chi square and Fisher’s exact tests determined the association of gender and age to the different ocular signs and symptoms. One-way analysis of variance (ANOVA) compared the average number of ocular symptoms among the different age groups. Results: A total of 121 patients, 20 males and 101 females, with thyroid disease were evaluated. 47.93% had Graves ophthalmopathy, occurring more frequently among patients aged between 30 and 49 years. The most common signs were eyelid retraction, proptosis, and lid lag. Conclusion Graves ophthalmopathy occurs frequently among patients with thyroid disease, especially those more than 30 years of age.
Graves Ophthalmopathy ; Graves Disease ; Exophthalmos ; Thyroid Diseases

PURPOSE: To evaluate the usefulness of exophthalmos measurement on upgaze in patients who are not able to expose corneal vertex on primary gaze. METHODS: The present study included 39 patients with blow out fracture, pseudotumor, or thyroid associated ophthalmopathy and 21 people who don't have any ocular disease. In total, 60 people had exophthalmometry using Hertel exophthalmometer on the basis of corneal vertex, inferior limbus, and inferior sclera by three examiners. RESULTS: The relative exophthalmometry in normal group was 0.71 +/- 0.75 mm, 0.67 +/- 0.62 mm, and 0.69 +/- 0.60 mm on the basis of corneal vertex, inferior limbus, and inferior sclera, respectively. The relative exophthalmometry in exophthalmic group was 1.10 +/- 0.99 mm, 1.13 +/- 0.99 mm, 1.10 +/- 0.91 mm on the basis of corneal vertex, inferior limbus, and inferior sclera, respectively. The relative exophthalmometry in enophthalmic group was 0.79 +/- 0.90 mm, 0.74 +/- 0.92 mm, 0.74 +/- 0.87 mm on the basis of corneal vertex, inferior limbus, and inferior sclera, respectively. There was no statistically significant difference between different measuring points (p > 0.05). The inter-examiner reproducibility was shown to be highly reliable. CONCLUSIONS: The upgaze exophthalmometry on the basis of inferior limbus or inferior sclera would be useful in the patients who are not able to expose corneal vertex on primary gaze.
Exophthalmos ; Graves Ophthalmopathy ; Humans ; Sclera

Graves' ophthalmopathy is the most common clinical orbital disease, and T helper (Th) cells play an important role in the development of Graves' ophthalmopathy. Th17 cells are a major subpopulation of Th cells and abnormally highly expressed in patients with Graves' ophthalmopathy. Th17 cells and the related cytokines interleukin (IL)-17A, IL-21 and IL-23 are involved in regulating the inflammatory response, fibrosis and adipogenesis. Th17 cells are unstable and exhibit a degree of plasticity, and they can differentiate into IL-17A and interferon (IFN)-γ dual-producing Th17.1 cells, which exacerbate the pathogenicity of Th17 cells. In addition, Th17 cells and the relevant factors are strongly associated with disease activity and severity in Graves' ophthalmopathy.
Humans ; Cytokines ; Th17 Cells ; Graves Ophthalmopathy ; Adipogenesis

Background: Asians with Graves’ ophthalmopathy (GO) may have earlier compressive features due to narrower orbital apex and increased orbital volume. Objective: To determine the risk factors associated with activity and severity of GO among adults. Methodology: This was a cross-sectional analytical study of 163 adults with Graves’ disease (GD) from the outpatient clinics of the Philippine General Hospital. Demographics, clinical data, thyrotropin receptor antibody (TRAb) and urine iodine (UIE) levels were obtained. All participants were evaluated for activity and severity of GO by a single ophthalmologist. Results: The population was predominantly composed of females (81%) and nonsmokers (69%), with a mean age of 35 + 11 years and median GD duration of 2 years. Median TRAb was 8.9 U/L while UIE was 171 mcg/L. Eight percent exhibited active GO, with 85% having mild disease. Multivariate analysis showed male sex to be associated with severe disease (OR 3.71, p=0.041), while elevated TRAb was associated with both active (OR 1.03, p=0.002) and severe GO (OR 1.02, p=0.007). Conclusion Lower rates of active and severe GO were seen compared to previous reports. In this population of predominantly nonsmokers, elevated TRAb emerged as a risk factor for active and severe GO.
Graves Ophthalmopathy ; Graves Disease ; Long-Acting Thyroid Stimulator

PURPOSE: to measure mood disturbance of Korean patients with dysthyroid ophthalmopathy according to the severity of ophthalmopathy. METHODS: Fifty patients with dysthyroid ophthalmopathy (mean age: 46.6+/-12.1 years; 32 female patients and 18 male patients) were included, and classified into 2 groups according to the disease severity. Twenty-five patients were classified with moderate/severe diseases (study group) and 25 patients classified with negligible/mild disease (control group). All patients completed a mood survey of 65 questions to assess differences in the degree of emotional distress. RESULTS: Analysis of each group showed that patients with moderate/severe ophthalmopathy had significantly greater emotional distress than patients with negligible/mild ophthalmopathy according to the Korean Profile of Mood States mean total score (p=0.03). In particular, patients with disfigurement (proptosis predominant group) had significantly worsen emotional distress compared with the control group (p=0.007), whereas patients with diplopia (diplopia predominant group) had no significant difference compared with the control group (p=0.60). CONCLUSIONS: Patients with moderate to severe ophthalmopathy have significant emotional distress, and severe mood disturbance especially when disfiguring signs are predominant. The psychological burden of the disease should be recognized, and routine follow-up recommended along with additional psychiatric consultation.
Diplopia ; Female ; Follow-Up Studies ; Graves Ophthalmopathy ; Humans ; Male

BACKGROUND AND OBJECTIVES: Dysthyroid ophthalmopathy is consider to be an autoimmune disorder and the disease is permanent in about 70% of the patients. Endoscopic intranasal approach for the decompression has been described by Kennedy in 1990. However a limitation of the approach is that decompression of the orbital floor lateral to the infraorbital nerve is not possible. So we modified caldwell- Luc's approach combined intranasal decompression by endoscopy. MATERIALS AND METHODS: We performed the orbital decompressions in 5 cases with the exophthalmos. When the inferior bony wall was removed, medial and lateral to the inferior orbital nerve were removed separately and bony ridge was created to protect the nerve. Upper one-third of the lateral wall was penetrated to make an space for herniation of orbital content in case of severe exphthalmos. RESULT: All of the cases were satisfied with the surgery and there has been no evidence of the recurrence so far. CONCLUSION: These combined techniques produce satisfactory results, especially in severe cases.
Decompression* ; Endoscopy ; Exophthalmos ; Graves Ophthalmopathy* ; Humans ; Orbit* ; Recurrence

PURPOSE: The same autoimmune process is thought to cause thyroid associated ophthalmopathy (TAO) and Graves' disease. The aim of this study is to determine hether thyroid autoantibody is related to the development of thyroid associated ophthalmopathy. METHODS: A retrospective chart analysis was performed on patients with a newly diagnosed Graves' disease, who presented to our ophthalmology clinic between January 2006 and December 2009. Thyroid autoantibody titers were obtained at the time of diagnosis and were used to determine the presence or absence of TAO. In addition, any correlations between thyroid autoantibodies were analyzed in patients with TAO. RESULTS: Thyroid autoantibody levels correlated with the development of TAO. Fifty-eight (69%) out of 84 patients with positive thyroid-stimulating hormone receptor antibody (TRAB) levels at the time of diagnosis had TAO. Only 50 (51%) of the 99 patients with negative TRAB levels had TAO. This difference between the two groups was statistically significant (odds ratio, OR=2.2, p=0.013). A statistically significant correlation with the development of TAO was also found in thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb), respectively (OR=0.5, p=0.317; OR=0.3, p=<0.001). In patients with TAO, the correlation between TPOAb and TgAb levels was very high (r=0.64, p=<0.001). CONCLUSIONS: A significant association was determined to exist between the development of TAO and thyroid autoantibody level. This result demonstrates the clinical utility of thyroid autoantibody for the diagnosis of TAO in patients with newly diagnosed Graves' disease.
Autoantibodies ; Graves Disease ; Graves Ophthalmopathy ; Humans ; Iodide Peroxidase ; Ophthalmology ; Retrospective Studies ; Thyroid Gland ; Thyrotropin ; Troleandomycin

Human ; Female ; Middle Aged ; Graves Disease ; Graves Ophthalmopathy ; Skin Diseases ; Methimazole ; Thyrotoxicosis