Background: The response to treatment in adult patients suffering from thyroid-eye-disease is variable, with resistant and relapsing cases. Clinical and therapeutic factors involved are not well established. Objectives: To identify clinical determinants of favourable outcome in a sample of adults with active thyroid orbitopathy who received multidisciplinary treatment and to evaluate the effect of long duration treatment approaches for moderate-to-severe cases. Methods: This retrospective observational study included patients treated in a hospital environment with a follow-up of more than 1 year. The criteria for a favourable outcome after treatment were a final Clinic Activity Score (CAS) < 2 and fewer than 3 posttreatment visits with a CAS > 1. The treatments used for moderate-to-severe orbitopathy were categorized according to duration. The following were considered long-duration treatments (LDTs): radiotherapy combined with intravenous corticosteroids; and tocilizumab. These LDTs were compared with treatments that were administered for up to 3 months. Fisher’s and Mann‒Whitney tests were used to verify relationships between qualitative and quantitative variables. Logistic and linear regressions were used to predict dichotomous and numerical variables. Results: Seventy-two patients were included in the study. Active smoking and sustained endocrine disease were associated with a longer duration of active orbitopathy (p = 0.045 and p <0.001, respectively). Radioiodine-induced hypothyroidism and arterial hypertension were negatively correlated with a favourable outcome event, with ORs of 0.12 (p = 0.008) and 0.16 (p = 0.019), respectively. LDTs were determinants of favourable outcome, with an odds ratio of 6.85 (p = 0.015). LDTs also led to a greater decrease in the CAS (p = 0.03). Conclusion: Active smoking, radioiodine-induced hypothyroidism, arterial hypertension, and sustained endocrine disease are associated with non-favourable outcome after treatment. LDTs contribute to favourable outcomes in adult patients with active moderate-to severe thyroid ophthalmopathy.
| Published in | International Journal of Ophthalmology & Visual Science (Volume 9, Issue 1) |
| DOI | 10.11648/j.ijovs.20240901.11 |
| Page(s) | 1-7 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Thyroid Orbitopathy, Thyroid-Associated Ophthalmopathy, Graves’ Disease, Thyroid-Eye-Disease, Outcome Determinants, Duration of Treatment
| [1] | Bartalena L, Kahaly GJ, Baldeschi L et al. EUGOGO. The 2021 European Group on Graves’ orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves’ orbitopathy, European Journal of Endocrinology. 2021; 185(4): G43–G67, https://doi.org/10.1530/EJE-21-0479 |
| [2] | Goh SY, Ho SC, Seah LL et al. Thyroid autoantibody profiles in ophthalmic dominant and thyroid dominant Graves’ disease differ and suggest ophthalmopathy is a multiantigenic disease. 2004; Clinical endocrinology. 2004; 60(5): 600-607, https://doi.org/10.1111/j.1365-2265.2004.02033.x |
| [3] | Eckstein A, Quadbeck B, Mueller G, et al. Impact of smoking on the response to treatment of thyroid associated ophthalmopathy. British Journal of Ophthalmology. 2003; 87: 773-776, http://dx.doi.org/10.1136/bjo.87.6.773 |
| [4] | Bartalena L, Piantanida E, Gallo D et al. Epidemiology, Natural History, Risk Factors, and Prevention of Graves’ Orbitopathy. 2020; Front. Endocrinol. 11: 615993, https://doi.org/10.3389/fendo.2020.615993 |
| [5] | Negro R, Hegedus L, Attanasio R et al. A 2018 European Thyroid Association survey on the use of selenium supplementation in Graves’ hyperthyroidism and Graves’orbitopathy. European Thyroid Journal 2019; 8: 7–15, https://doi.org/10.1159/000494837 |
| [6] | Johnson, KTM, Wittig A, Loesch C et al. A retrospective study on the efficacy of total absorbed orbital doses of 12, 16 and 20 Gy combined with systemic steroid treatment in patients with Graves’ orbitopathy. Graefes Arch Clin Exp Ophthalmol. 2010; 248: 103-109, https://doi.org/10.1007/s00417-009-1214-3 |
| [7] | San Miguel I, Arenas M, Carmona R et al. Review of the treatment of Graves’ ophthalmopathy: the role of the new radiation techniques. Saudi Journal of Ophthalmology. 2018; 32(2): 139-145. https://doi.org/10.1016/j.sjopt.2017.09.003 |
| [8] | Wiersinga W M, Perros P, Kahaly GJ et al. Clinical assessment of patients with Graves’ orbitopathy: the European Group on Graves’ Orbitopathy recommendations to generalists, specialists and clinical researchers, 2006; European Journal of Endocrinology. 2006; 155(3): 387-389, https://doi.org/10.1530/eje.1.02230 |
| [9] | Menconi F, Leo M, Sabini E et al. Natural history of graves’ orbitopathy after treatment. Endocrine 2017; 57: 226–233. DOI: 10.1007/s12020-016-1136-x. |
| [10] | Burch, H B, Perros P, Bednarczuk T et al. Management of thyroid eye disease: a Consensus Statement by the American Thyroid Association and the European Thyroid Association. Thyroid, 2022; 32(12): 1439-1470. https://doi.org/10.1089/thy.2022.0251 |
| [11] | Khong JJ, Finch S, De Silva C et al. Risk Factors for Graves' Orbitopathy; the Australian Thyroid-Associated Orbitopathy Research (ATOR) Study. J Clin Endocrinol Metab. 2021; 101(7): 2711-20. https://doi.org/ 10.1210/jc.2015-4294 |
| [12] | Perros P, Kendall-Taylor P, Neoh C et al. A prospective study on the effects of radioiodine therapy for hyperthyroidism in patients with minimally active Graves’ophthalmopathy. J Clin Endocrinol Metab 2005; 90: 5321-5323. https://doi.org/10.1210/jc.2005-0507 |
| [13] | Naselli A, Moretti D, Regalbuto C et al. Evidence that baseline levels of lowdensity lipoproteins cholesterol affect the clinical response of Graves’ophthalmopathy to parenteral corticosteroids. Frontiers in Endocrinology 2020; 11: 609895. https://doi.org/10.3389/fendo.2020.609895 |
| [14] | Stoynova, M. A., Shinkov, A. D., Novoselski, M. T. et al. Changes in therapeutic response, ocular manifestations of Graves’ orbitopathy and quality of life during the first year after orbital radiotherapy. Int Ophthalmol 2023; 43: 4305–4314. https://doi.org/10.1007/s10792-023-02842-8 |
| [15] | Lara PC, Burgos J, Macias D. Low dose lung radiotherapy for COVID-19 pneumonia. The rationale for a cost-effective anti-inflammatory treatment. Clinical and Translational Radiation Oncology 2020: 23: 27-29 https:// doi.org/10.1016/j.ctro.2020.04.006 |
APA Style
Rutllan-Civit, J., Rodríguez-González, F., Salas-Salas, B., Ferrera, L., Juan, L., et al. (2024). Determinants of Favourable Outcome Among Adults with Active Thyroid Eye Disease: The Remarkable Role of Long-Duration Treatment Approaches. International Journal of Ophthalmology & Visual Science, 9(1), 1-7. https://doi.org/10.11648/j.ijovs.20240901.11
ACS Style
Rutllan-Civit, J.; Rodríguez-González, F.; Salas-Salas, B.; Ferrera, L.; Juan, L., et al. Determinants of Favourable Outcome Among Adults with Active Thyroid Eye Disease: The Remarkable Role of Long-Duration Treatment Approaches. Int. J. Ophthalmol. Vis. Sci. 2024, 9(1), 1-7. doi: 10.11648/j.ijovs.20240901.11
AMA Style
Rutllan-Civit J, Rodríguez-González F, Salas-Salas B, Ferrera L, Juan L, et al. Determinants of Favourable Outcome Among Adults with Active Thyroid Eye Disease: The Remarkable Role of Long-Duration Treatment Approaches. Int J Ophthalmol Vis Sci. 2024;9(1):1-7. doi: 10.11648/j.ijovs.20240901.11
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.ijovs.20240901.11,
author = {Joaquim Rutllan-Civit and Fayna Rodríguez-González and Bárbara Salas-Salas and Laura Ferrera and Lucía Juan and Raquel Cabrera and Marta Lloret and Francisco Medina-Rivero and Jesús-María González-Martín and Pedro De Pablos-Velasco},
title = {Determinants of Favourable Outcome Among Adults with Active Thyroid Eye Disease: The Remarkable Role of Long-Duration Treatment Approaches},
journal = {International Journal of Ophthalmology & Visual Science},
volume = {9},
number = {1},
pages = {1-7},
doi = {10.11648/j.ijovs.20240901.11},
url = {https://doi.org/10.11648/j.ijovs.20240901.11},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20240901.11},
abstract = {Background: The response to treatment in adult patients suffering from thyroid-eye-disease is variable, with resistant and relapsing cases. Clinical and therapeutic factors involved are not well established. Objectives: To identify clinical determinants of favourable outcome in a sample of adults with active thyroid orbitopathy who received multidisciplinary treatment and to evaluate the effect of long duration treatment approaches for moderate-to-severe cases. Methods: This retrospective observational study included patients treated in a hospital environment with a follow-up of more than 1 year. The criteria for a favourable outcome after treatment were a final Clinic Activity Score (CAS) 1. The treatments used for moderate-to-severe orbitopathy were categorized according to duration. The following were considered long-duration treatments (LDTs): radiotherapy combined with intravenous corticosteroids; and tocilizumab. These LDTs were compared with treatments that were administered for up to 3 months. Fisher’s and Mann‒Whitney tests were used to verify relationships between qualitative and quantitative variables. Logistic and linear regressions were used to predict dichotomous and numerical variables. Results: Seventy-two patients were included in the study. Active smoking and sustained endocrine disease were associated with a longer duration of active orbitopathy (p = 0.045 and p Conclusion: Active smoking, radioiodine-induced hypothyroidism, arterial hypertension, and sustained endocrine disease are associated with non-favourable outcome after treatment. LDTs contribute to favourable outcomes in adult patients with active moderate-to severe thyroid ophthalmopathy.
},
year = {2024}
}
TY - JOUR T1 - Determinants of Favourable Outcome Among Adults with Active Thyroid Eye Disease: The Remarkable Role of Long-Duration Treatment Approaches AU - Joaquim Rutllan-Civit AU - Fayna Rodríguez-González AU - Bárbara Salas-Salas AU - Laura Ferrera AU - Lucía Juan AU - Raquel Cabrera AU - Marta Lloret AU - Francisco Medina-Rivero AU - Jesús-María González-Martín AU - Pedro De Pablos-Velasco Y1 - 2024/01/18 PY - 2024 N1 - https://doi.org/10.11648/j.ijovs.20240901.11 DO - 10.11648/j.ijovs.20240901.11 T2 - International Journal of Ophthalmology & Visual Science JF - International Journal of Ophthalmology & Visual Science JO - International Journal of Ophthalmology & Visual Science SP - 1 EP - 7 PB - Science Publishing Group SN - 2637-3858 UR - https://doi.org/10.11648/j.ijovs.20240901.11 AB - Background: The response to treatment in adult patients suffering from thyroid-eye-disease is variable, with resistant and relapsing cases. Clinical and therapeutic factors involved are not well established. Objectives: To identify clinical determinants of favourable outcome in a sample of adults with active thyroid orbitopathy who received multidisciplinary treatment and to evaluate the effect of long duration treatment approaches for moderate-to-severe cases. Methods: This retrospective observational study included patients treated in a hospital environment with a follow-up of more than 1 year. The criteria for a favourable outcome after treatment were a final Clinic Activity Score (CAS) 1. The treatments used for moderate-to-severe orbitopathy were categorized according to duration. The following were considered long-duration treatments (LDTs): radiotherapy combined with intravenous corticosteroids; and tocilizumab. These LDTs were compared with treatments that were administered for up to 3 months. Fisher’s and Mann‒Whitney tests were used to verify relationships between qualitative and quantitative variables. Logistic and linear regressions were used to predict dichotomous and numerical variables. Results: Seventy-two patients were included in the study. Active smoking and sustained endocrine disease were associated with a longer duration of active orbitopathy (p = 0.045 and p Conclusion: Active smoking, radioiodine-induced hypothyroidism, arterial hypertension, and sustained endocrine disease are associated with non-favourable outcome after treatment. LDTs contribute to favourable outcomes in adult patients with active moderate-to severe thyroid ophthalmopathy. VL - 9 IS - 1 ER -
Ophthalmology Department, University Hospital of Gran Canaria "Doctor Negrín", Las Palmas de Gran Canaria, Spain
Ophthalmology Department, University Hospital of Gran Canaria "Doctor Negrín", Las Palmas de Gran Canaria, Spain
Radiation Oncology Department, University Hospital of Gran Canaria "Doctor Negrín", Las Palmas de Gran Canaria, Spain
Radiation Oncology Department, University Hospital of Gran Canaria "Doctor Negrín", Las Palmas de Gran Canaria, Spain
Radiation Oncology Department, University Hospital of Gran Canaria "Doctor Negrín", Las Palmas de Gran Canaria, Spain
Radiation Oncology Department, University Hospital of Gran Canaria "Doctor Negrín", Las Palmas de Gran Canaria, Spain
Radiation Oncology Department, University Hospital of Gran Canaria "Doctor Negrín", Las Palmas de Gran Canaria, Spain
Ophthalmology Department, University Hospital of Gran Canaria "Doctor Negrín", Las Palmas de Gran Canaria, Spain
Research Unit, University Hospital of Gran Canaria "Doctor Negrín", Las Palmas de Gran Canaria, Spain
Endocrinology Department, University Hospital of Gran Canaria "Doctor Negrín", Las Palmas de Gran Canaria, Spain
Information