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Moledina M, Damato EM, Lee V. The changing landscape of thyroid eye disease: current clinical advances and future outlook. Eye (Lond) 2024; 38:1425-1437. [PMID: 38374366 PMCID: PMC11126416 DOI: 10.1038/s41433-024-02967-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 01/07/2024] [Accepted: 01/26/2024] [Indexed: 02/21/2024] Open
Abstract
AIMS This review aims to provide an overview of the current understanding of TED and its pathophysiology. To describe the evidence base for current consensus treatment recommendations and newer biological therapies available as well as to present future therapeutic research. METHODS We reviewed and assessed the peer-reviewed literature placing particular emphasis on recent studies evaluating the pathophysiology of TED, landmark trials forming the basis of current management and recent clinical trials informing future therapeutics. Searched were made in MEDLINE Ovid, Embase Ovid, US National Institutes of Health Ongoing Trials Register and EU Clinical Trials Register. Keywords included: "Thyroid Eye Disease", "Graves Orbitopathy", "Thyroid Orbitopathy" and "Graves' Ophthalmopathy". RESULTS AND CONCLUSIONS The pathophysiology of TED involves a complex array of cellular and humoral based autoimmune dysfunction. Previous therapies have been broad-based acting as a blunt instrument on this mechanism with varying efficacy but often accompanied with a significant side effect profile. The recent development of targeted therapy, spearheaded by Teprotumumab has led to an array of treatments focusing on specific components of the molecular pathway optimising their impact whilst possibly minimising their side effect profile. Future challenges involve identifying the most effective target for each patient rather than any single agent being a panacea. Long-term safety profiles will require clarification as unintended immunological consequence downstream may become manifest as seen in other diseases. Finally, future novel therapeutics will entail significant expenditure and may lead to a divergence of available treatment modalities between healthcare systems due to funding disparities.
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Affiliation(s)
- Malik Moledina
- Oculoplastics Service, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Erika M Damato
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Vickie Lee
- Oculoplastics Service, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK.
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2
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Smith TJ, Cockerham K, Barretto N, Hirst A, Oliver L, Enstone A, Brandolini G, Taylor SD, Holt RJ. Bridging and Validation of the Specific Graves Ophthalmopathy Quality of Life Questionnaire With Health State Utility Values. Endocr Pract 2024; 30:470-475. [PMID: 38341128 DOI: 10.1016/j.eprac.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE In thyroid eye disease (TED), inflammation and expansion of orbital muscle and periorbital fat result in diplopia and proptosis, severely impacting patient quality of life (QOL). The reported health state utility (HSU) scores, which are QOL measures, allow quantification of TED impact and improvement with therapies; however, no current QOL instrument has been validated with HSU scores for TED. Here, we used the disease-specific Graves Ophthalmopathy Quality of Life (GO-QOL) questionnaire and HSU scores to validate QOL impact. METHODS The GO-QOL scores from patients in 2 randomized, masked, placebo-controlled teprotumumab trials (N=171) were compared with 6 HSU values based on severity of proptosis/diplopia in those studies. Patient GO-QOL and HSU scores were compared at baseline and after 6-month treatment via regression analyses. GO-QOL and HSU scores were correlated for validation and quantification of QOL impact by severity state and to estimate quality-adjusted life year improvement. RESULTS GO-QOL scores were correlated with TED severity, indicating that worse severity was associated with lower (worse) GO-QOL scores. Less severe health states were represented by higher (better) GO-QOL scores. Importantly, GO-QOL scores were positively correlated with utility scores of the 6 health states, allowing for conversion of the GO-QOL scores to utility scores. A positive (improved) 0.013 utility change was found for each 1-point (positive) improvement in GO-QOL score produced by teprotumumab versus placebo. CONCLUSION Patients with moderate-to-severe active TED health states demonstrate increasing TED severity associated with declining utility values and worsening GO-QOL scores. These results indicate that the GO-QOL scores can be used to bridge to the HSU scores for benefit quantification.
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Affiliation(s)
- Terry J Smith
- Department of Ophthalmology and Visual Sciences and Department of Internal Medicine, Kellogg Eye Center-Michigan Medicine and University of Michigan, Ann Arbor, Michigan
| | | | | | - Alex Hirst
- Adelphi Values PROVE, Manchester, United Kingdom
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Parunakian E, Ugradar S, Tolentino J, Malkhasyan E, Raika P, Ghaly J, Bisht C, Douglas RS. Teprotumumab improves light sensitivity in patients with thyroid eye disease. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06491-0. [PMID: 38639788 DOI: 10.1007/s00417-024-06491-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/01/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Teprotumumab, a novel IGF-1R antibody, has been shown to significantly reduce the signs of acute and chronic Thyroid Eye Disease (TED). Light sensitivity is a reported symptom in patients with TED. There is a lack of a prospective study that has explored the effects on light sensitivity in a large cohort of patients with acute and chronic TED following treatment with teprotumumab. METHODS Consecutive patients who were diagnosed with TED and reported light sensitivity at baseline were considered for study eligibility. All patients had measurements of Visual Light Sensitivity Questionnaire-8 (VLSQ-8), proptosis, clinical activity score (CAS), and MRD1 (distance between the upper eyelid margin and corneal reflex, mm) and MRD2 (distance between the lower eyelid margin and corneal reflex, mm) before and after treatment. RESULTS Ninety patients (41 acute, 49 chronic) met the inclusion criteria. The mean (SD) age was 47.3 (14.3). Eighty-six (95.6%) patients completed all 8 infusions. There was a significant reduction in the total score and across all categories of the VLSQ-8 (p < 0.01 for all). Seventy-two (80%) patients had a clinically significant improvement (≥2 reduction) in at least one category. There was no significant difference in the total VLSQ-8 score between the acute and chronic group (p = 0.8). CONCLUSION Teprotumumab improves light sensitivity in patients with acute and chronic TED. The results of this study highlight that the improvements in light sensitivity following treatment are not directly related to the mechanical changes in TED, suggesting another underlying mechanism is potentially involved.
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Jinhai Y, Yunxiu C, Chao X, Yaohua W, Kai Y, Hongfei L. A meta-analysis of the efficacy of two-wall orbital decompression operations for thyroid-associated ophthalmopathy. Int Ophthalmol 2024; 44:81. [PMID: 38358400 DOI: 10.1007/s10792-024-03039-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND The main treatment for the symptoms of proptosis and optic nerve compression caused by thyroid-associated ophthalmopathy is orbital decompression surgery. Medial inferior wall decompression and balanced decompression are two frequently used surgical procedures. However, there is no unified consensus on how to choose different surgical options for orbital decompression in clinical practice. AIMS To compare the effects of medial inferior wall decompression and balanced decompression surgery through meta-analysis and to provide reference for clinical optimal decision making. METHODS Databases, including PubMed, Web of Science, Ovid, Cochrane Library, and ClinicalTrials.gov, were searched for randomized controlled trials and cohort studies on decompression surgery for thyroid-associated ophthalmopathy published from inception to March 21, 2023. Using RevMan 5.3 software, a meta-analysis was conducted based on the following outcome indicators: proptosis, diplopia rate, intraocular pressure, visual acuity, and complication rate. RESULTS Two randomized controlled trials and five cohort studies with a total of 377 patients were included in this analysis. After balanced decompression surgery, patients with thyroid-associated ophthalmopathy experienced a significant decrease in proptosis [MD = 4.92, 95% CI (4.26, 5.58), P < 0.0001]. Balanced decompression can improve postoperative visual acuity [MD = - 0.35, 95% CI (- 0.56, - 0.13), P = 0.001] and intraocular pressure [MD = 5.33, 95% CI (3.34, 7.32), P < 0.0001]. The rates of proptosis [MD = 0.33, 95% CI (- 1.80, 2.46), P = 0.76] and diplopia [OR = 1.20, 95% CI (0.38, 3.76), P = 0.76] did not differ between patients who underwent medial inferior wall decompression and those who underwent balanced decompression. CONCLUSION Balanced decompression and medial inferior wall decompression are both effective options for surgical treatment of thyroid-associated ophthalmopathy in clinical practice.
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Affiliation(s)
- Yu Jinhai
- School of Optometry, Jiangxi Medical College, Nanchang University, No. 463 Bayi Avenue, Nanchang, 330006, Jiangxi, China
- Jiangxi Research Institute of Ophthalmology and Visual Science, Nanchang, China
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, China
| | - Chen Yunxiu
- School of Optometry, Jiangxi Medical College, Nanchang University, No. 463 Bayi Avenue, Nanchang, 330006, Jiangxi, China
- Jiangxi Research Institute of Ophthalmology and Visual Science, Nanchang, China
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, China
| | - Xiong Chao
- School of Optometry, Jiangxi Medical College, Nanchang University, No. 463 Bayi Avenue, Nanchang, 330006, Jiangxi, China
- Jiangxi Research Institute of Ophthalmology and Visual Science, Nanchang, China
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, China
| | - Wang Yaohua
- The Affiliated Eye Hospital, Jiangxi Medical College Nanchang University, No. 463 Bayi Avenue, Nanchang, 330006, Jiangxi, China.
- Jiangxi Clinical Research Center for Ophthalmic Disease, Nanchang, China.
| | - Yuan Kai
- The Affiliated Eye Hospital, Jiangxi Medical College Nanchang University, No. 463 Bayi Avenue, Nanchang, 330006, Jiangxi, China
- Jiangxi Clinical Research Center for Ophthalmic Disease, Nanchang, China
| | - Liao Hongfei
- The Affiliated Eye Hospital, Jiangxi Medical College Nanchang University, No. 463 Bayi Avenue, Nanchang, 330006, Jiangxi, China.
- Jiangxi Clinical Research Center for Ophthalmic Disease, Nanchang, China.
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Zhou M, Lin B, Wu P, Ke Y, Huang S, Zhang F, Hei X, Mao Z, Li X, Wan P, Chen T, Yang H, Huang D. SOX9 Induces Orbital Fibroblast Activation in Thyroid Eye Disease Via MAPK/ERK1/2 Pathway. Invest Ophthalmol Vis Sci 2024; 65:25. [PMID: 38345552 PMCID: PMC10866156 DOI: 10.1167/iovs.65.2.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/12/2023] [Indexed: 02/15/2024] Open
Abstract
Purpose To evaluate the expression of sry-box transcription factor 9 (SOX9) in orbital fibroblasts (OFs) of thyroid eye disease (TED) and to find its potential role and underlying mechanism in orbital fibrosis. Methods OFs were cultured from orbital connective tissues obtained from patients with TED (n = 10) and healthy controls (n = 6). SOX9 was depleted by small interfering RNA or overexpressed through lentivirus transduction in OFs. Fibroblast contractile activity was measured by collagen gel contraction assay and proliferation was examined by EdU assay. Transcriptomic changes were assessed by RNA sequencing. Results The mRNA and protein levels of SOX9 were significantly higher in OFs cultured from patients with TED than those from healthy controls. Extracellular matrix-related genes were down-regulated by SOX9 knockdown and up-regulated by SOX9 overexpression in TED-OFs. SOX9 knockdown significantly decrease the contraction and the antiapoptotic ability of OFs, whereas the overexpression of SOX9 increased the ability of transformation, migration, and proliferation of OFs. SOX9 knockdown suppressed the expression of phosphorylated ERK1/2, whereas its overexpression showed the opposite effect. Epidermal growth factor receptor (EGFR) is one of the notably down-regulated genes screened out by RNA sequencing. Chromatin immunoprecipitation-qPCR demonstrated SOX9 binding to the EGFR promoter. Conclusions A high expression of SOX9 was found in TED-OFs. SOX9 can activate OFs via MAPK/ERK1/2 signaling pathway, which in turn promotes proliferation and differentiation of OFs. EGFR was a downstream target gene of SOX9. SOX9/EGFR can be considered as therapeutic targets for the treatment of orbital fibrosis in TED.
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Affiliation(s)
- Min Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong Province, China
| | - Bingying Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong Province, China
| | - Pengsen Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong Province, China
| | - Yu Ke
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong Province, China
| | - Siyu Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong Province, China
| | - Fan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong Province, China
| | - Xiangqing Hei
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong Province, China
| | - Zhen Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong Province, China
| | - Xingyi Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong Province, China
| | - Pengxia Wan
- Department of Ophthalmology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Tingting Chen
- Department of Ophthalmology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong Province, China
| | - Danping Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong Province, China
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Douglas RS, Couch S, Wester ST, Fowler BT, Liu CY, Subramanian PS, Tang R, Nguyen QT, Maamari RN, Ugradar S, Hsu K, Karon M, Stan MN. Efficacy and Safety of Teprotumumab in Patients With Thyroid Eye Disease of Long Duration and Low Disease Activity. J Clin Endocrinol Metab 2023; 109:25-35. [PMID: 37925673 PMCID: PMC10735297 DOI: 10.1210/clinem/dgad637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
CONTEXT Early inflammatory thyroid eye disease (TED) can lead to symptomatic chronic disease, including disabling proptosis. Teprotumumab, an insulin-like growth factor-1 receptor (IGF-1R) inhibitor, previously demonstrated efficacy in acute, high-inflammation TED trials. OBJECTIVE We present data from the first placebo-controlled trial with teprotumumab in chronic/low disease activity TED. METHODS This randomized double-masked, placebo-controlled trial, conducted at 11 US centers, enrolled adult participants with TED duration of 2 to 10 years, Clinical Activity Score (CAS) ≤ 1 or no additional inflammation or progression in proptosis/diplopia for ≥1 year, proptosis ≥3 mm from before TED and/or from normal, euthyroid/mildly hypo/hyperthyroid, no prior teprotumumab, and no steroids within 3 weeks of baseline. Patients received (2:1) intravenous teprotumumab or placebo once every 3 weeks (total 8 infusions). The primary endpoint was proptosis (mm) improvement at Week 24. Adverse events (AEs) were assessed. RESULTS A total of 62 (42 teprotumumab and 20 placebo) patients were randomized. At Week 24, least squares mean (SE) proptosis improvement was greater with teprotumumab (-2.41 [0.228]) than with placebo (-0.92 [0.323]), difference -1.48 (95% CI -2.28, -0.69; P = .0004). Proportions of patients with AEs were similar between groups. Hyperglycemia was reported in 6 (15%) vs 2 (10%) and hearing impairment in 9 (22%) vs 2 (10%) with teprotumumab and placebo, respectively. AEs led to discontinuation in 1 teprotumumab (left ear conductive hearing loss with congenital anomaly) and 1 placebo patient (infusion-related). There were no deaths. CONCLUSION Teprotumumab significantly improved proptosis vs placebo in longstanding/low inflammation TED, demonstrating efficacy regardless of disease duration/activity. The safety profile was comparable to that previously reported.
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Affiliation(s)
- Raymond S Douglas
- Department of Ophthalmology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Steven Couch
- John F. Hardesty MD Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO 63130, USA
| | - Sara T Wester
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
| | - Brian T Fowler
- Department of Ophthalmology, The University of Tennessee Health Science Center, Hamilton Eye Institute, Memphis, TN 38163, USA
| | - Catherine Y Liu
- Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92037, USA
| | - Prem S Subramanian
- Departments of Ophthalmology, Neurology, and Neurosurgery, UC Health Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Department of Surgery, Division of Ophthalmology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Rosa Tang
- Eye Wellness Center, Neuro-Eye Clinical Trials, Inc., Houston, TX 77074, USA
| | - Quang T Nguyen
- Department of Endocrinology, Touro University, Henderson, NV 89014, USA
| | - Robi N Maamari
- John F. Hardesty MD Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO 63130, USA
| | - Shoaib Ugradar
- Department of Ophthalmology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Kate Hsu
- Clinical Development, Horizon Therapeutics plc, Deerfield, IL 60015, USA
| | - Michael Karon
- Clinical Development, Horizon Therapeutics plc, Deerfield, IL 60015, USA
| | - Marius N Stan
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, MN 55905, USA
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Smith TJ, Hegedüs L, Lesser I, Perros P, Dorris K, Kinrade M, Troy-Ott P, Wuerth L, Nori M. How patients experience thyroid eye disease. Front Endocrinol (Lausanne) 2023; 14:1283374. [PMID: 38027128 PMCID: PMC10665908 DOI: 10.3389/fendo.2023.1283374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To determine the impact of thyroid eye disease (TED) on patients in various stages of the disease. Background TED is a debilitating and potentially sight-threatening inflammatory autoimmune disease that is frequently misdiagnosed. Challenging quality-of-life (QoL) issues can persist long after the active phase of disease has subsided. Methods A 62-question survey was designed as a hypothesis-generating instrument to identify key issues confronting patients ≥18 years old with physician-diagnosed TED. Questions focused primarily on physical and emotional status, and QoL experiences in the 2 months prior to the survey. Data for individual questions are presented as summary statistics. Correlations between questions were determined using χ2 analyses. Results The 443 respondents were 18 to >80 years old; >90% female, and >80% from the United States. Time since TED diagnosis ranged from <1 year to >10 years. Participants provided >500 free-form responses describing experiences of living with TED. Physical signs/symptoms were experienced by 307/443 (69%) patients. Of those responding to the QoL questions (N = 394), 53 (13%) reported symptoms improving, 73 (19%) reported symptoms worsening, and 255 (65%) reported no change in the 2 months prior to the survey. The most bothersome signs/symptoms were dry/gritty eyes, light sensitivity, bulging eyes, and pressure or pain behind the eyes. Respondents <60 years were significantly (p < 0.0001) more likely to report symptomatic TED than older patients. Of 394 respondents, 179 (45%) reported feeling depressed and/or anxious, 174 (44%) reported concern about their appearance, and 73 (19%) avoided public situations; 192 (49%) reported declines in confidence or feelings of general well-being, and 78 (20%) reported an inability to achieve goals. Activities limited by TED included reading, driving, and socializing. The proportion of respondents experiencing these negative QoL measures was higher when patients reported experiencing >5 symptoms, had been diagnosed within the last 5 years, or were <60 years of age. Conclusions Physical manifestations of TED impact QoL for patients through all phases of the disease. It is essential that physicians and healthcare professionals become more familiar with patient experiences such as those described here to better help patients manage their disease.
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Affiliation(s)
- Terry J. Smith
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Ira Lesser
- Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Petros Perros
- Institute of Translational and Clinical Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kimberly Dorris
- Graves’ Disease and Thyroid Foundation, Rancho Santa Fe, CA, United States
| | - Michele Kinrade
- Scientific Solutions, RareLife Solutions, Inc., Westport, CT, United States
| | - Patti Troy-Ott
- Scientific Solutions, RareLife Solutions, Inc., Westport, CT, United States
| | - Laura Wuerth
- Scientific Solutions, RareLife Solutions, Inc., Westport, CT, United States
| | - Mukund Nori
- Scientific Solutions, RareLife Solutions, Inc., Westport, CT, United States
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Jiang W, Liu J, Zhou J, Wu Q, Pu X, Chen H, Xu X, Wu F, Hu H. Altered dynamic brain activity and functional connectivity in thyroid-associated ophthalmopathy. Hum Brain Mapp 2023; 44:5346-5356. [PMID: 37515416 PMCID: PMC10543102 DOI: 10.1002/hbm.26437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Although previous neuroimaging evidence has confirmed the brain functional disturbances in thyroid-associated ophthalmopathy (TAO), the dynamic characteristics of brain activity and functional connectivity (FC) in TAO were rarely concerned. The present study aims to investigate the alterations of temporal variability of brain activity and FC in TAO using resting-state functional magnetic resonance imaging (rs-fMRI). Forty-seven TAO patients and 30 age-, gender-, education-, and handedness-matched healthy controls (HCs) were enrolled and underwent rs-fMRI scanning. The dynamic amplitude of low-frequency fluctuation (dALFF) was first calculated using a sliding window approach to characterize the temporal variability of brain activity. Based on the dALFF results, seed-based dynamic functional connectivity (dFC) analysis was performed to identify the temporal variability of efficient communication between brain regions in TAO. Additionally, correlations between dALFF and dFC and the clinical indicators were analyzed. Compared with HCs, TAO patients displayed decreased dALFF in the left superior occipital gyrus (SOG) and cuneus (CUN), while showing increased dALFF in the left triangular part of inferior frontal gyrus (IFGtriang), insula (INS), orbital part of inferior frontal gyrus (ORBinf), superior temporal gyrus (STG) and temporal pole of superior temporal gyrus (TPOsup). Furthermore, TAO patients exhibited decreased dFC between the left STG and the right middle occipital gyrus (MOG), as well as decreased dFC between the left TPOsup and the right calcarine fissure and surrounding cortex (CAL) and MOG. Correlation analyses showed that the altered dALFF in the left SOG/CUN was positively related to visual acuity (r = .409, p = .004), as well as the score of QoL for visual functioning (r = .375, p = .009). TAO patients developed abnormal temporal variability of brain activity in areas related to vision, emotion, and cognition, as well as reduced temporal variability of FC associated with vision deficits. These findings provided additional insights into the neurobiological mechanisms of TAO.
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Affiliation(s)
- Wen‐Hao Jiang
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Jun Liu
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Jiang Zhou
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Qian Wu
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Xiong‐Ying Pu
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Huan‐Huan Chen
- Department of EndocrinologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Xiao‐Quan Xu
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Fei‐Yun Wu
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Hao Hu
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
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9
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Nirmalan A, Blecher N, Hyder S, Couch SM, Godfrey KJ, Stan MN, Bradley EA, Wagner LH, Tooley AA. Alemtuzumab-Induced Thyroid Eye Disease: A Comprehensive Case Series and Review of the Literature. Ophthalmic Plast Reconstr Surg 2023; 39:470-474. [PMID: 36893061 DOI: 10.1097/iop.0000000000002367] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
PURPOSE To present 5 cases of alemtuzumab-induced thyroid eye disease (AI-TED) and review the literature to highlight the natural history, severity, and outcomes as compared with conventional thyroid eye disease (TED). METHODS A multi-institutional retrospective case series of patients with AI-TED was compiled. Chart review evaluated for clinical characteristics, imaging findings, and treatment for AI-TED. Additionally, a comprehensive review of the literature identified all previously published cases of AI-TED. RESULTS Five new patients with AI-TED were included in this series. The average clinical activity score on presentation was 2.8 (range 1-4) and reached an average peak of 5.0 during the active phase of the disease (4-7). Patients were treated medically with selenium (40%) or monoclonal antibodies including teprotumumab or tocilizumab (40%). Surgical treatment with orbital decompression for compressive optic neuropathy was performed on 2 (40%) patients. Combined with 11 previously reported cases, these 16 patients with AI-TED had an average clinical activity score on presentation of 3.3. The average length of the AI-TED phase was 14.0 months, and all patients were treated with medical and/or surgical interventions for their disease. CONCLUSIONS Clinical and imaging findings in AI-TED mirror that of conventional TED, however, AI-TED may present with greater severity. AI-TED may develop many months after Graves' disease; therefore, providers should be aware of this association and monitor patients for the development of severe TED.
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Affiliation(s)
- Aravindh Nirmalan
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Nathanael Blecher
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Sayyada Hyder
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Steven M Couch
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Kyle J Godfrey
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
| | - Marius N Stan
- Department of Endocrinology, Mayo Clinic College of Medicine, Rochester, Minnesota, U.S.A
| | - Elizabeth A Bradley
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Lilly H Wagner
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Andrea A Tooley
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
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10
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Hu Y, Chen J, Lin K, Yu X. Efficacy and Safety of intravenous monoclonal antibodies in patients with moderate-to-severe active Graves'ophthalmopathy: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1160936. [PMID: 37288301 PMCID: PMC10242093 DOI: 10.3389/fendo.2023.1160936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023] Open
Abstract
Backgrounds The effects of various treatments on Graves' ophthalmopathy (GO) have been studied. As monoclonal antibodies (mAbs) have been proposed for the treatment of moderate to severe GO, direct comparisons between different mAbs are lacking.We therefore conducted this meta-analysis to objectively compare the efficacy and safety of intravenous mAbs. Methods To identify eligible trials, references published before September 2022 were electronically searched in PubMed, Web of Science, Pubmed, Embase,Cochrane Library, CBM, CNKI,Wan-Fang and ICTRP databases.The Newcastle-Ottawa scale (NOS) and the Cochrane Risk of Bias Assessment Tool were used to assess the risk of bias of the original studies.The primary and secondary outcomes were the response and inactivation rates, with the secondary outcomes being the clinical activity score (CAS),the improvement of proptosis and diplopia improvement,and the adverse event rate. Publication bias was evaluated, along with subgroup and sensitivity analyses. Results A total of 12 trials with 448 patients were included. The meta-analysis showed that TCZ (tocilizumab) was most likely to be the best treatment in terms of response according to indirect contrast, followed by TMB (teprotumumab) and RTX (rituximab).TCZ, followed by TMB and RTX, was also most likely to be the best treatment in terms of reducing proptosis. In terms of improving diplopia, TMB was most likely to be the best treatment, followed by TCZ and RTX.TCZ was the highest probability of safety, followed by RTX and TMB. Conclusions Based on the best available evidence,TCZ should be the preferred treatment for moderate to severe GO.In the absence of head-to-head trials,indirect comparisons of treatments are routinely used to estimate the effectiveness of the treatments of interest. In addition,the optimal dose and potential mechanism of action of monoclonal antibodies remain to be established,and it is encouraging that the treatment paradigm for GO may change in the future.This study was designed in accordance with the Preferred Reporting Items for conducting Systematic Reviews and Meta-Analyses (PRISMA)(27). Systematic Review Registration http://www.crd.york.ac.uk/prospero, identifier CRD42023398170.
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Affiliation(s)
- Yu Hu
- Laboratory of Endocrinology and Metabolism/Department of Endocrinology and Metabolism, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Endocrinology and Metabolism, Chengdu First People’s Hospital, Chengdu, China
| | - Jinhua Chen
- Department of General Practice, Chengdu First People’s Hospital, Chengdu, China
| | - Ken Lin
- Department of Endocrinology and Metabolism, Chengdu First People’s Hospital, Chengdu, China
| | - Xijie Yu
- Laboratory of Endocrinology and Metabolism/Department of Endocrinology and Metabolism, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
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11
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Lee TC, Radha-Saseendrakumar B, Delavar A, Ye GY, Ting MA, Topilow NJ, Bass J, Korn BS, Kikkawa DO, Baxter SL, Liu CY. Evaluation of Depression and Anxiety in a Diverse Population With Thyroid Eye Disease Using the Nationwide NIH All of Us Database. Ophthalmic Plast Reconstr Surg 2023; 39:281-287. [PMID: 36727790 DOI: 10.1097/iop.0000000000002318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the prevalence of depression and anxiety among individuals with thyroid eye disease (TED) and identify sociodemographic risk factors using the NIH All of Us database. METHODS Three hundred ninety eight cases with TED were compared with 1,592 controls with demographics matching the 2020 US Census. Primary outcomes were diagnosed depression or anxiety; Patient Health Questionnaire-9 (PHQ-9) scores and General Anxiety Disorder-7 (GAD-7) scores were included as secondary outcomes. We performed multivariable logistic regression to generate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between TED and depression and anxiety. RESULTS Patients with TED were more likely to have depression (OR 2.72, 95% CI 2.08-3.56, p < 0.001) and anxiety (OR 2.82, 95% CI 2.16-3.70, p < 0.001) than controls. In patients with TED, female gender was an independent risk factor for both depression (OR 1.72; 95% CI 1.00-5.07, p = 0.05) and anxiety (OR 2.17, 95% CI 1.25-3.85, p = 0.006). Unemployment (OR 1.72, 95% CI 1.03-2.94, p = 0.04) and lower income (OR 0.88 for income as a continuous variable, 95% CI 0.79-0.99, p = 0.03) were risk factors for anxiety. Risk factors for more severe depression as assessed by PHQ-9 included lower income (OR 0.70, 95% CI 0.57-0.85, p < 0.001), and protective factors included Black race (OR 0.12, 95% CI 0.02-0.45, p = 0.002). Lower income was associated with more severe anxiety as assessed by GAD-7 (OR 0.77, 95% CI 0.64-0.94, p = 0.009). CONCLUSIONS Patients with TED were more likely to develop depression and anxiety compared with controls. This study highlights the psychosocial impact of TED and associated socioeconomic risk factors.
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Affiliation(s)
- Tonya C Lee
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
| | - Bharanidharan Radha-Saseendrakumar
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Arash Delavar
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Gordon Y Ye
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Michelle A Ting
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Nicole J Topilow
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Jeremy Bass
- Department of Psychiatry, University of California San Diego, La Jolla, California, U.S.A
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Sally L Baxter
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
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Ugradar S, Zimmerman E, Parunakian E, Kang J, Cockerham K, Douglas RS. Change in lacrimal gland volume and aqueous tear production following treatment with teprotumumab. Clin Exp Ophthalmol 2023. [PMID: 36723406 DOI: 10.1111/ceo.14208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/02/2023] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dry eye syndrome occurs in up to 85% of patients with thyroid eye disease (TED). Lacrimal gland enlargement correlates with subjective tearing and a reduction in quality of life in patients with TED. METHODS In this prospective longitudinal study, patients presenting for the treatment of TED were considered for eligible. Primary outcomes included a change in the volume of the lacrimal gland and the production of tears following treatment with teprotumumab. The volume of lacrimal glands and proptosis was calculated using 3D volumetric analysis. Tear production was measured by Schirmer's test and associated symptoms were assessed using the VLSQ-8. The orbit with the most proptosis was designated the study orbit and the contralateral orbit was designated the fellow orbit. RESULTS Twenty patients were included. Mean (SD) age was 61 (18) and mean duration of TED prior to therapy was 48 months (47). Lacrimal gland volume in the study orbit decreased from 768 mm3 (288) to 486 mm3 (173) (p < 0.01) following therapy. For the fellow orbit, volume reduced from 637 mm3 (261) to 379 mm3 (147) (p < 0.01). Schirmer's test reading (STR) in the study orbit increased from 14.5 mm (8.2) to 23 mm (10) (p < 0.01) (59%) following treatment. In the fellow orbit, STR increased from 12.7 mm (7) to 21 mm (9) post therapy (69%) (p < 0.01). There was a significant improvement on all parts of the VLSQ-8. CONCLUSION Teprotumumab significantly reduces TED related expansion of the lacrimal gland, increases tear production, and improves dry eye symptoms.
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Affiliation(s)
- Shoaib Ugradar
- The Jules Stein Eye Institute University of California, Los Angeles, California, USA
| | - Erin Zimmerman
- The Jules Stein Eye Institute University of California, Los Angeles, California, USA
| | | | - Julia Kang
- Cedars-Sinai Medical Centre, Los Angeles, California, USA
| | - Kimberly Cockerham
- Central Valley Eye Medical Group, Stockton, California, USA.,Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
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Fallahi P, Ragusa F, Paparo SR, Elia G, Balestri E, Mazzi V, Patrizio A, Botrini C, Benvenga S, Ferrari SM, Antonelli A. Teprotumumab for the treatment of thyroid eye disease. Expert Opin Biol Ther 2023; 23:123-131. [PMID: 36695097 DOI: 10.1080/14712598.2023.2172328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Thyroid eye disease (TED) is an autoimmune disease characterized by inflammation of orbital and extraocular muscles. It induces proptosis and diplopia, leading to a worsening of quality of life (QoL) because of its impact on physical appearance, and visual function. The natural history involves an 'active TED,' which is an autoimmune inflammatory response targeting orbital soft tissues, and 'inactive TED,' where there is tissue expansion remodeling. To date, glucocorticoids represent the main medical therapy, even if often ineffective and associated with side effects. AREAS COVERED In TED, the autoimmune process leads to production of TSH-R and IGF-1 R autoantibodies. This induces inflammatory changes in the orbital tissue, and activation of fibroblasts with accumulation of glycosaminoglycans, leading to consequent proptosis, and diplopia. In two previous randomized, double-masked, placebo-controlled, parallel-group, multicenter trials, teprotumumab has been shown to be effective in improving proptosis, inflammation, diplopia, and QoL. More recently, it has been shown that teprotumumab is also effective in chronic-inactive TED. Teprotumumab was approved by the FDA on 21 January 2020 for the treatment of TED. EXPERT OPINION For the above-mentioned reasons teprotumumab represents a potential first line therapy for TED that could replace the use of steroids in the next future.
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Affiliation(s)
- Poupak Fallahi
- Department of Translational Research of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesca Ragusa
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Sabrina Rosaria Paparo
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Giusy Elia
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Eugenia Balestri
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Valeria Mazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Armando Patrizio
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Chiara Botrini
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Messina, Italy.,Interdepartmental Program of Molecular & Clinical Endocrinology, and Women's Endocrine Health, University Hospital, Policlinico Universitario G. Martino, Messina, Italy
| | | | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
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14
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Nie T, Lamb YN. Teprotumumab: A Review in Thyroid Eye Disease. Drugs 2022; 82:1663-1670. [DOI: 10.1007/s40265-022-01804-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/26/2022]
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15
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Wang Y, Shao Y, Zhang H, Wang J, Zhang P, Zhang W, Chen H. Comprehensive analysis of key genes and pathways for biological and clinical implications in thyroid-associated ophthalmopathy. BMC Genomics 2022; 23:630. [PMID: 36056316 PMCID: PMC9440526 DOI: 10.1186/s12864-022-08854-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background Thyroid-associated ophthalmopathy (TAO) is a common and organ-specific autoimmune disease. Early diagnosis and novel treatments are essential to improve the prognosis of TAO patients. Therefore, the current work was performed to identify the key genes and pathways for the biological and clinical implications of TAO through comprehensive bioinformatics analysis and a series of clinical validations. Methods GSE105149 and GSE185952 were obtained from the Gene Expression Omnibus (GEO) database for analysis. The data were normalized to identify the common differentially expressed genes (DEGs) between the two datasets, and the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted to assess key pathways in TAO. Protein–protein interaction (PPI) networks and hub genes among the common DEGs were identified. Furthermore, we collected the general information and blood samples from 50 TAO patients and 20 healthy controls (HCs), and the expression levels of the proteins encoded by hub genes in serum were detected by enzyme-linked immunosorbent assay (ELISA). Then we further assessed the relationship between the ELISA data and the TAO development. Results Several common pathways, including neuroactive ligand-receptor interaction, the IL-17 signaling pathway, and the TNF signaling pathway, were identified in both datasets. In parallel, 52 common DEGs were identified. The KEGG analysis showed that these common DEGs are mainly enriched in long-term depression, the VEGF signaling pathway, the IL-17 signaling pathway, the TNF signaling pathway, and cytokine-cytokine receptor interactions. The key hub genes PRKCG, OSM, DPP4, LRRTM1, CXCL6, and CSF3R were screened out through the PPI network. As confirmation, the ELISA results indicated that protein expression levels of PRKCG, OSM, CSF3R, and DPP4 were significantly upregulated in TAO patients compared with HCs. In addition, PRKCG and DPP4 were verified to show value in diagnosing TAO, and CSF3R was found to be a valuable diagnostic marker in distinguishing active TAO from inactive TAO. Conclusions Inflammation- and neuromodulation-related pathways might be closely associated with TAO. Based on the clinical verification, OSM, CSF3R, CXCL6, DPP4, and PRKCG may serve as inflammation- or neuromodulation-related biomarkers for TAO, providing novel insights for the diagnosis and treatment of TAO. Supplementary Information The online version contains supplementary material available at 10.1186/s12864-022-08854-5.
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Affiliation(s)
- Yueyue Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanfei Shao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haitao Zhang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Wang
- Department of Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Peng Zhang
- Department of Ophthalmology, The Friendship Hospital of Ili Kazakh Autonomous Prefecture Ili & Jiangsu Joint Institute of Health, Ili, China
| | - Weizhong Zhang
- Department of Ophthalmology, The Friendship Hospital of Ili Kazakh Autonomous Prefecture Ili & Jiangsu Joint Institute of Health, Ili, China. .,Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Huanhuan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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16
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Sharma A, Stan MN, Rootman DB. Measuring Health-Related Quality of Life in Thyroid Eye Disease. J Clin Endocrinol Metab 2022; 107:S27-S35. [PMID: 36346683 PMCID: PMC9359445 DOI: 10.1210/clinem/dgac230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Indexed: 02/13/2023]
Abstract
Health-related quality of life (HQOL) is a concept that aims to understand the totality of an individual's experience of their disease state. This can include the physical, psychosocial, emotional, and psychological effects of a disease state. A complex and multifactorial concept, HQOL can be challenging to measure accurately and reliably. Thyroid eye disease (TED), as a multifaceted physically debilitating and facial disfiguring disorder, presents unique challenges and opportunities in the measurement of HQOL. Multiple distinct tools have been developed for this purpose, each has been constructed, assessed, and utilized. This discussion surveys the landscape of TED-related QOL measurement and presents challenges for the future. Clinicians and clinical researchers should implement TED-related QOL measurement as part of routine TED care and as a primary outcome in TED clinical trials. We recommend utilizing the Graves' ophthalmopathy (GO)-QOL routinely in clinical practice and as a primary outcome in TED clinical trials. If the GO-QOL is too time-consuming or in mild TED, a faster alternative is the TED-QOL.
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Affiliation(s)
- Anu Sharma
- Division of Endocrinology, Metabolism and Diabetes, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Marius N Stan
- Division of Endocrinology, Mayo Clinic, Rochester, MN 55905, USA
| | - Dan B Rootman
- Correspondence: Daniel B. Rootman, MD, MS, Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye Institutes, University of California, Los Angeles, 100 Stein Plaza #2-267, Los Angeles, CA 90095, USA.
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17
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Yu CY, Ford RL, Wester ST, Shriver EM. Update on thyroid eye disease: Regional variations in prevalence, diagnosis, and management. Indian J Ophthalmol 2022; 70:2335-2345. [PMID: 35791115 PMCID: PMC9426067 DOI: 10.4103/ijo.ijo_3217_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Thyroid eye disease (TED) is a rare disease that can lead to decreased quality of life, permanent disfigurement, and vision loss. Clinically, TED presents with exophthalmos, periorbital edema, extraocular muscle dysfunction, and eyelid retraction, and can lead to vision-threatening complications such as exposure to keratopathy and dysthyroid optic neuropathy (DON). Over the last several years, significant advancements have been made in the understanding of its pathophysiology as well as optimal management. Ethnic variations in the prevalence, clinical presentation, and risk of vision-threatening complications of TED are summarized, and risk factors associated with TED are discussed. Additionally, significant advances have been made in the management of TED. The management of TED traditionally included anti-inflammatory medications, orbital radiation therapy, orbital surgical decompression, and biologic therapies. Most recently, targeted therapies such as teprotumumab, an insulin-like growth factor-1 receptor antagonist, have been studied in the context of TED, with promising initial data. In this review, updates in the understanding and management of TED are presented with a focus on the international variations in presentation and management.
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Affiliation(s)
- Caroline Y Yu
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Rebecca L Ford
- Department of Ophthalmology, Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sara T Wester
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Erin M Shriver
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
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Jiang WH, Chen HH, Chen W, Wu Q, Chen L, Zhou J, Xu XQ, Hu H, Wu FY. Altered Long- and Short-Range Functional Connectivity Density in Patients With Thyroid-Associated Ophthalmopathy: A Resting-State fMRI Study. Front Neurol 2022; 13:902912. [PMID: 35812093 PMCID: PMC9259934 DOI: 10.3389/fneur.2022.902912] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/13/2022] [Indexed: 11/22/2022] Open
Abstract
Background and Purpose Although previous neuroimaging studies have demonstrated emotion- and psychology-associated brain abnormalities in patients with thyroid-associated ophthalmopathy (TAO), the changes of brain functional connectivity in TAO were seldom focused. We aimed to investigate interregional and intraregional functional interactions in patients with TAO by using resting-state functional MRI (rs-fMRI) with long- and short-range functional connectivity density (FCD) analysis. Methods Thirty patients with TAO and 30 well-matched healthy controls (HCs) were recruited in our study. Long- and short-range FCD values were calculated and compared between the two groups. Correlations between long- and short-range FCD values and clinical indicators were analyzed. Results Compared with HCs, patients with showed both increased long- and short-range FCDs in the left middle frontal gyrus (MFG), orbital part of superior frontal gyrus (ORBsup), and dorsolateral part of superior frontal gyrus (SFGdor); meanwhile, both decreased long- and short-range FCDs in bilateral postcentral gyrus (PoCG), left superior parietal gyrus (SPG), and inferior parietal (IPL). In addition, patients with TAO showed increased short-range FCD in the right SFGdor, bilateral medial part of superior frontal gyrus (SFGmed), left orbital part of middle frontal gyrus (ORBmid), and orbital part of inferior frontal gyrus (ORBinf), as well as decreased short-range FCD in the right supplementary motor area (SMA) and the left paracentral lobule (PCL) than HCs. Moreover, the short-range value in the left SFGdor showed a negative correlation with Montreal Cognitive Assessment (MoCA) score (r = −0.501, p = 0.005). Conclusion Our findings complemented the functional neural mechanism of TAO, and provided potential neuroimaging markers for assessing the psychiatric, visual, and emotional disturbances in patients with TAO.
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Affiliation(s)
- Wen-Hao Jiang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wen Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lu Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiang Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Hao Hu
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Fei-Yun Wu
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Zhong BL, Xu YM, Li Y. Prevalence and Unmet Need for Mental Healthcare of Major Depressive Disorder in Community-Dwelling Chinese People Living With Vision Disability. Front Public Health 2022; 10:900425. [PMID: 35812506 PMCID: PMC9257003 DOI: 10.3389/fpubh.2022.900425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/31/2022] [Indexed: 12/29/2022] Open
Abstract
Objective Mental health services have been recognized as an essential part of the comprehensive eye care services, but data regarding the mental health of people living with vision disability (PLwVD) remain very limited. This study examined the epidemiology of major depressive disorder (MDD) among Chinese PLwVD, as well as their perceived needs for and utilization of mental health services. Methods By using stratified cluster sampling method, a total of 1,753 PLwVD were successfully recruited from 73 urban communities and 169 rural villages in Wuhan, China, and interviewed with the Mini-international Neuropsychiatric Interview 5.0. Standardized questions were used to measure perceived mental healthcare needs and use of mental health services of PLwVD with MDD. Results The one-month prevalence of MDD was 24.4%. Among the PLwVD with MDD, 26.0% perceived needs for mental healthcare and only 1.2% sought treatment from mental health specialists for their emotional problems. Factors associated with MDD were middle age [vs. young adulthood, odds ratio (OR) = 1.96, P < 0.001], older adulthood (vs. young adulthood, OR = 1.79, P = 0.004), being never-married (vs. married, remarried, and cohabiting, OR = 1.96, P < 0.001), being separated, divorced, and widowed (vs. married, remarried, and cohabiting, OR = 12.30, P < 0.001), a low level of objective social support (vs. high, OR = 1.83, P < 0.001), currently drinking (OR = 1.81, P < 0.001), having childhood-onset eye conditions (OR = 1.89, P = 0.005), and having difficulties in performing daily activities (OR = 2.78, P < 0.001). Conclusions Chinese PLwVD are at high risk for MDD and have a high level of unmet need for mental healthcare. Public strategies are warranted to improve the mental health literacy of PLwVD and make the mental health services available, accessible, and affordable for PLwVD.
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Affiliation(s)
- Bao-Liang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Yan-Min Xu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Yi Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
- *Correspondence: Yi Li
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Wang Y, Padnick-Silver L, Francis-Sedlak M, Holt RJ, Foley C, Douglas RS. Inflammatory and non-inflammatory thyroid eye disease: comparison of disease signs, symptoms and quality of life in US patients. Endocr Pract 2022; 28:842-846. [PMID: 35714862 DOI: 10.1016/j.eprac.2022.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Thyroid eye disease (TED) is an autoimmune, inflammatory disease resulting in retro-orbital fat and extraocular muscle expansion. TED quiets ("inactivates") as inflammation wanes, but signs/symptoms often persist. Disease signs/symptoms and quality of life (QOL) impact were examined in non-inflammatory and inflammatory TED. METHODS Moderate-to-severe TED patient data were collected from treating physicians. Clinical activity score (CAS, 6/7 measures available) assessed TED as inflammatory (CAS≥3) or non-inflammatory (CAS=0-1). QOL impact was scored as 1="not at all impaired" to 7="extremely impaired." Non-inflammatory TED patients were further grouped into longer (>3 years) and shorter (≤3 years) disease. RESULTS Inflammatory (N=307) and non-inflammatory (N=281) patients had comparable age (50.0±13.3, 48.3±13.8 years), sex (66%, 64% female), TED duration (4.0±4.9; 4.6±5.5 years), and proportion smokers (15%, 11%). Most common non-inflammatory TED signs/symptoms included ocular dryness/grittiness (77%), proptosis (56%), excessive tearing (43%), soft tissue edema (42%), conjunctival redness (24%) decreased vision (24%) and eye muscle involvement (22%; 14% had diplopia). All were less reported than in patients with inflammatory TED. QOL was impacted by non-inflammatory TED, but to a lesser degree than inflammatory disease (3.6±1.5 vs. 4.7±1.4). However, mental health issues were similarly reported. Non-inflammatory TED patients with longer disease (9.0±6.0 years) had similar QOL impact, mental health diagnoses, and TED sign/symptoms as those with shorter disease (1.4±1.0 years). CONCLUSION TED signs/symptoms often chronically persist long after TED has "quieted," continuing to impact patient QOL and mental health. These data suggest that moderate-to-severe TED should be thought of as a robust symptomatic chronic disease, regardless of inflammatory status.
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Affiliation(s)
- Yao Wang
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | | | | | | | | | - Raymond S Douglas
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California
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Ulhaq ZS, Soraya GV, Dewi NA, Wulandari LR. The prevalence of anxiety symptoms and disorders among ophthalmic disease patients. Ther Adv Ophthalmol 2022; 14:25158414221090100. [PMID: 35464342 PMCID: PMC9021519 DOI: 10.1177/25158414221090100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/09/2022] [Indexed: 12/26/2022] Open
Abstract
Background: Progressive and irreversible vision loss has been shown to place a patient at risk of mental health problems such as anxiety. However, the reported prevalence of anxiety symptoms and disorders among eye disease patients vary across studies. Thus, this study aims to clarify the estimated prevalence of anxiety symptoms and disorders among ophthalmic disease patients. Methods: Relevant studies on the prevalence of anxiety symptoms and disorders among eye disease patients were collected through international databases, PubMed, Scopus, and Web of Science. A random-effects model was used to determine the pooled prevalence of anxiety symptoms and disorders among ophthalmic disease patients. Results: The 95 included studies yielded a pooled prevalence of 31.2% patients with anxiety symptoms and 19.0% with anxiety disorders among subjects with ophthalmic disease. Pediatric patients were more anxious (58.6%) than adults (29%). Anxiety symptoms were most prevalent in uveitis (53.5%), followed by dry eye disease (DED, 37.2%), retinitis pigmentosa (RP, 36.5%), diabetic retinopathy (DR, 31.3%), glaucoma (30.7%), myopia (24.7%), age-related macular degeneration (AMD, 21.6%), and cataract (21.2%) patients. Anxiety disorders were most prevalent in thyroid eye disease (TED, 28.9%), followed by glaucoma (22.2%) and DED (11.4%). When compared with healthy controls, there was a twofold increase on the prevalence of anxiety symptoms (OR = 1.912, 95% CI 1.463–2.5, p < 0.001) and anxiety disorders (OR = 2.281, 95% CI 1.168–4.454, p = 0.016). Conclusion: Anxiety symptoms and disorders are common problems associated with ophthalmic disease patients. Thus, comprehensive and appropriate treatments are necessary for treating anxiety symptoms and disorders among ophthalmic disease patients.
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Affiliation(s)
- Zulvikar Syambani Ulhaq
- Research Center for Pre-Clinical and Clinical Medicine, National Research and Innovation Agency Republic of Indonesia, Cibinong, Indonesia
| | - Gita Vita Soraya
- Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Nadia Artha Dewi
- Department of Ophthalmology, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Lely Retno Wulandari
- Department of Ophthalmology, Faculty of Medicine, Brawijaya University, Malang, Indonesia
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