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

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: 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

No abstract available.
Graves Disease*

No abstract available.
Graves Disease*

Graves' disease (GD) and Guillain-Barre syndrome (GBS) are both autoimmune disorders and are triggered by interactions between genetic and environmental factors. GBS in patients who suffer from other autoimmune diseases is rarely reported, and the development of atypical GBS with cranial nerve involvement in a patient with GD has never been previously reported. Herein, we report a patient with GD and a rare form of pharyngo-cervico-brachial variety of GBS.

Graves' disease (GD) can lead to specific eye afflictions including proptosis, periorbital swelling, conjunctival injection, chemosis, and opthalmoplegia, which then become a condition called Graves' ophthalmopathy or thyroid-associated ophthalmopathy (TAO). A carotid cavernous fistula (CCF) is an abnormal vascular communication between the carotid artery and the cavernous sinus. The clinical signs of CCF are very similar to TAO and should be considered as a differential diagnosis of TAO. We would like to present an interesting case of a bilateral ophthalmopathy induced by CCF in a GD patient. A 54-year-old man with a 6-year history of GD presented with bilateral exophthalmos and conjunctival injection for two months. The orbital CT scan findings were consistent with CCF, and an angiography revealed bilateral CCF. He received a bilateral coil embolization for the CCF and his ophthalmic signs were immediately improved. We recommend orbital imaging to exclude other coexisting diseases in patients who are suspected of TAO, especially when the diagnosis is uncertain or when determining whether medical or surgical intervention is appropriate.
Angiography ; Carotid Arteries ; Cavernous Sinus ; Caves ; Diagnosis, Differential ; Exophthalmos ; Eye ; Fistula ; Graves Disease ; Graves Ophthalmopathy ; Humans ; Middle Aged ; Orbit ; Troleandomycin

BACKGROUND AND OBJECTIVES: Little has been known for factors predicting improvement of proptosis in patients with thyroid-associated ophthalmopathy (TAO) after intravenous (IV) glucocorticoid therapy. This study aimed to evaluate the efficacy of IV glucocorticoid therapy and to find factor predicting treatment outcomes in patients with TAO. MATERIALS AND METHODS: Forty-two consecutive patients with TAO treated by IV glucocorticoid from 2000 to 2009 were retrospectively analyzed. They received IV methylprednisolone of 7.0 g over 18 weeks. Before and after treatment, patients underwent orbital CT for assessment of proptosis and extraocular muscle hypertrophy, and physical examination for clinical activity score (CAS). RESULTS: Thirteen patients (31%) showed improvement in proptosis after therapy. High extraocular muscle diameter index was an independent predictor for improvement in proptosis (odds ratio=1.25, p=0.03). Smoking, age, gender and initial CAS did not predict improvement. Seven of 16 patients with initial CAS<3 (43%) and 13 of 17 with initial CAS> or =3 (77%) showed improvement in diplopia after treatment (p=0.002). Of patients with CAS> or =3, patients with intermittent, inconstant and constant diplopia showed improvement in diplopia in 100%, 80% and 63%, respectively. Of patients with CAS<3, patients showed improvement in 80%, 33% and 20%, respectively. CONCLUSION: Presence of extraocular muscle hypertrophy was the only factor predicting improvement in proptosis after IV glucocorticoid therapy. In patients with TAO, IV glucocorticoid therapy could be considered to improve proptosis when they present with increased extraocular muscle diameter, or to improve diplopia especially when they also have high initial CAS.
Diplopia ; Exophthalmos ; Graves Disease ; Graves Ophthalmopathy ; Humans ; Hypertrophy ; Methylprednisolone ; Muscles ; Orbit ; Physical Examination ; Retrospective Studies ; Smoke ; Smoking ; Troleandomycin

The polymorphisms of thyroid stimulating hormone receptor (TSHR) intron 1 rs179247 and rs12101255 have been found to be associated with Graves' disease (GD) in genetic studies. In the present study, we conducted a meta-analysis to examine this association. Two reviewers systematically searched eligible studies in PubMed, Web of Science, Embase and China Biomedical Literature Database (CBM). A meta-analysis on the association between GD and TSHR intron 1 rs179247 or rs12101255 was performed. The odd ratios (OR) were estimated with 95% confidence interval (CI). Meta package in R was used for the analyses. Seven articles (13 studies) published between 2009 and 2014, involving 5754 GD patients and 5768 controls, were analyzed. The polymorphism of rs179247 was found to be associated with an increased GD risk in the allele analysis (A vs. G: OR=1.40, 95% CI=1.33-1.48) and all genetic models (AA vs. GG: OR=1.94, 95% CI=1.73-2.19; AA+AG vs. GG: OR=1.57, 95% CI=1.41-1.74; AA vs. AG+GG: OR=1.54, 95% CI=1.43-1.66). The site rs12101255 also conferred a risk of GD in the allele analysis (T vs. C: OR=1.50, 95% CI=1.40-1.60) and all genetic models (TT vs. CC: OR=2.22, 95% CI=1.92-2.57; TT+TC vs. CC: OR=1.66, 95% CI=1.50-1.83; TT vs. TC+CC: OR=1.74, 95% CI=1.53-1.98). Analysis of the relationship between rs179247 and Graves' ophthalmopathy (GO) showed no statistically significant correlation (A vs. G: OR=1.02, 95% CI=0.97-1.07). Publication bias was not significant. In conclusion, GD is associated with polymorphisms of TSHR intron 1 rs179247 and rs12101255. There is no association between rs179247 SNPs and GO.
China ; Female ; Genetic Association Studies ; Genetic Predisposition to Disease ; Graves Disease ; genetics ; pathology ; Graves Ophthalmopathy ; genetics ; pathology ; Humans ; Introns ; genetics ; Male ; Polymorphism, Single Nucleotide ; Receptors, Thyrotropin ; genetics ; Risk Factors