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Toro-Tobon D, Rachmasari KN, Bradley EA, Wagner LH, Tooley AA, Stokken JK, Stan MN. Medical Therapy in Patients with Moderate to Severe, Steroid-Resistant, Thyroid Eye Disease. Thyroid 2023; 33:1237-1244. [PMID: 37515425 DOI: 10.1089/thy.2023.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
Background: Corticosteroid therapy is often employed in thyroid eye disease (TED), but its efficacy is variable. Teprotumumab and tocilizumab have been considered as effective alternatives. This study aims to evaluate their clinical outcomes and safety in patients with steroid-resistant TED. Methods: A retrospective case-control study was conducted between 2018 and 2022 within a national multicenter health system. Thirty-seven patients with moderate to severe steroid-resistant TED treated with teprotumumab or tocilizumab (cases) were compared with steroid-naïve patients treated with similar therapy (controls). Due to lack of steroid-naïve patients treated with tocilizumab, a control subgroup for tocilizumab was not included in the analysis. Demographic and clinical characteristics were described. Proptosis, diplopia, clinical activity score (CAS), and disease severity (European Group on Graves' orbitopathy classification) were evaluated at weeks 0, 12, 24, and 52 after therapy initiation. Results: Thirty-one patients received teprotumumab (13 cases and 18 controls) and 6 received tocilizumab (cases). The mean age was 57 years (standard deviation ±14.3), median duration of TED was 11.5 months (interquartile range [IQR]: 7.2-17.7), and median excess proptosis was 4 mm (IQR: 2-8) above the upper limit of normal for sex and race. At week 24, in the teprotumumab cases, 81% had proptosis response (reduction of ≥2 mm), 45.5% resolution of diplopia, 85.7% disease inactivation (CAS <3), and 58.3% reverted to mild disease severity. There were comparable results in teprotumumab controls, with no significant differences between subgroups. In the tocilizumab cases, 50% had a proptosis response, 16.7% resolution of diplopia, 100% disease inactivation, and 75% returned to mild disease. In the teprotumumab cases, there was a trend toward worsening proptosis and diplopia between weeks 24 and 52. In the same time frame, the tocilizumab cases had a trend toward worsening diplopia, disease activity, and severity. In the teprotumumab subgroup, 46.2% experienced otic changes and 23.1% hyperglycemia. In the tocilizumab subgroup, there were no reported adverse events. Conclusions: Teprotumumab and tocilizumab improved inflammation in patients with moderate to severe TED who had failed previous steroid therapy. Additionally, the teprotumumab cases demonstrated similar improvement in proptosis and diplopia to the teprotumumab controls. Further evaluation, particularly regarding the long-term response and side effect profile, of these medications in steroid-resistant TED is needed.
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Affiliation(s)
- David Toro-Tobon
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Kharisa N Rachmasari
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Lilly H Wagner
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrea A Tooley
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Janalee K Stokken
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marius N Stan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
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Rachmasari KN, Strauss SB, Phillips CD, Lantos JE, An A, Cisse B, Ramakrishna R, Schwartz TH, Dobri GA. Posterior hypothalamic involvement on pre-operative MRI predicts hypothalamic obesity in craniopharyngiomas. Pituitary 2023; 26:105-114. [PMID: 36462067 DOI: 10.1007/s11102-022-01294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Hypothalamic obesity (HO) is a complication associated with craniopharyngioma (CP). Attempts have been made to perioperatively predict the development of this complication, which can be severe and difficult to treat. METHODS Patients who underwent first transsphenoidal surgical resection in a single center between February 2005 and March 2019 were screened; those who have had prior surgery or radiation, were aged below 18 years, or did not have follow up body mass index (BMI) after surgery were excluded. Primary end point was BMI within 2 years post-surgery. Hypothalamic involvement (HI) was graded based on preoperative and postoperative imaging with regards to anterior, posterior, left and right involvement. Data on baseline demographics, pre-operative and post-operative MRI, and endocrine function were collected. RESULTS 45 patients met the inclusion and exclusion criteria. Most patients in our cohort underwent gross total resection (n = 35 patients). 13 patients were from no HI or anterior HI only group and 22 patients were classified as both anterior (ant) and posterior (post) HI group. There was no significant difference between the two groups in the gross total, subtotal or near total resection. Pre-operative BMI and post-operative BMI were significantly higher in patients who had ant and post HI on pre-operative MRI (p < 0.05 and p < 0.01, respectively). Similarly, post-operative BMI at 13-24 months was also significantly higher in the ant and post HI group on post-op MRI (p < 0.01). There was no significant difference between the two groups in terms of baseline adrenal insufficiency, thyroid insufficiency, gonadal insufficiency, IGF-1 levels, hyperprolactinemia, and diabetes insipidus. Diabetes insipidus was more common following surgery among those who had anterior and posterior involvement on pre-operative MRI (p < 0.05). CONCLUSIONS HO appears to be predetermined by tumor involvement in the posterior hypothalamus observed on pre-operative MRI. Posterior HI on pre-operative MRI was also associated with the development of diabetes insipidus after surgery.
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Affiliation(s)
- Kharisa N Rachmasari
- Department of Medicine, New York-Presbyterian Hospital - Weill Cornell Medicine, New York, NY, USA.
| | - Sara B Strauss
- Department of Neuroradiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Joshua E Lantos
- Department of Neuroradiology, Weill Cornell Medicine, New York, NY, USA
| | - Anjile An
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Babacar Cisse
- Department of Neurosurgery, Weill Cornell Medicine, New York, NY, USA
| | - Rohan Ramakrishna
- Department of Neurosurgery, Weill Cornell Medicine, New York, NY, USA
| | | | - Georgiana A Dobri
- Department of Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Endocrinology, Weill Cornell Medicine, New York, NY, USA
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Wagner LH, Bradley EA, Tooley AA, Ren Y, Rachmasari KN, Stan MN. Thyroid eye disease or Graves' orbitopathy: What name to use, and why it matters. Front Endocrinol (Lausanne) 2022; 13:1083886. [PMID: 36518254 PMCID: PMC9742525 DOI: 10.3389/fendo.2022.1083886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
There is currently no universally accepted name for inflammatory disease of the eye and orbit associated with thyroid autoimmune disease. Variability in terminology impedes the evaluation of scientific literature and clinical collaboration and can affect patients' understanding of a disease process. The goals of this perspective article are 1. To compare the frequency of different terms used for eye disease associated with autoimmune thyroid disease in the scientific literature between 2000, 2010 and 2020 publications; 2. To investigate potential associations of terminology with author and journal specialty, and multidisciplinary vs. mono-disciplinary author teams; 3. To determine preferential terms used by professional societies; and 4. To propose standardized terminology based on our data analysis. The methods for this study included review of all English language articles listed in PubMed, with publication dates in the years 2000, 2010 and 2020, that included one of 6 terms currently used to describe eye disease associated with autoimmune thyroid disease. Characteristics pertaining to authors, journals, and article type were recorded. Results showed that the most used term in the 2000 literature was Graves' Ophthalmopathy (61%). In the 2010 literature, Graves' Orbitopathy (31%) became most common, followed by Graves' Ophthalmopathy (30%). Between 2010 and 2020, thyroid eye disease (37%) became the most common term, followed by Graves' Orbitopathy (35%). This perspective article proposes "thyroid eye disease" (TED) as the preferred name for this entity and discusses supporting terminology patterns and trends over time in scientific literature and in professional societies.
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Affiliation(s)
- Lilly H. Wagner
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Lilly H. Wagner,
| | | | - Andrea A. Tooley
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
| | - Yanhan Ren
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
| | | | - Marius N. Stan
- Division of Endocrinology, Mayo Clinic, Rochester, MI, United States
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Rachmasari KN, Strauss SB, Phillips CD, Lantos J, An A, Schwartz TH, Dobri GA. MON-LB45 Posterior Hypothalamic Involvement on Pre-Operative Magnetic Resonance Imaging as a Predictor for Hypothalamic Obesity in Craniopharyngiomas. J Endocr Soc 2020. [PMCID: PMC7208879 DOI: 10.1210/jendso/bvaa046.2224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Craniopharyngioma (CP) is a rare embryonic tumor of the sellar and parasellar region with benign histology (World Health Organization grade I) thought to arise from embryonic remnants of Rathke’s pouch. Despite its high survival rates, this tumor can lead to severe morbidity secondary to destruction of adjacent structures. Hypothalamus (HT) is a brain region that has a central role in regulating body weight through a complex mechanism involving central and peripheral signaling pathways. Destruction of its distinctive nuclei induces hyperphagia, hyperinsulinemia and weight gain. Seventy-five patients with CP who underwent first surgical resection in a single center by the same neurosurgeon between February 2005 and March 2019 were screened; those who have had prior radiation, were aged below 18 years, or did not have follow up body mass index (BMI) after surgery were excluded. Ultimately, this study included 45 patients with a mean age 50.5 years, 73.3% women. Pre and post-operative MRI were independently reviewed by three neuroradiologists to determine involvement of the hypothalamic regions: anterior, anterior and posterior, or no hypothalamic involvement. Body mass index were recorded pre operatively and subsequently after TSS up to 24 months post operation. Association between hypothalamic region involvement and BMI as well as endocrine function were examined. Posterior hypothalamic involvement seen in pre operative MRI (N=28) was significantly associated with higher BMI at 3-6 month, 7-12 month, and 13-24 month follow up (p < 0.05) in comparison to involvement of anterior hypothalamic alone or no hypothalamic involvement. Similarly, posterior hypothalamic involvement in the pre and post-operative MRI was significantly associated with development of diabetes insipidus (DI) (p < 0.05) compared to anterior or no hypothalamic involvement. There was no association between pre-operative BMI and hypothalamic involvement. Although the weight gain was accelerated after surgery, there was no association between post operative MRI and ensuing BMI, suggesting that the damage of the hypothalamic nuclei was done by the CP rather than surgical procedure. Conclusion: Assessment of hypothalamic involvement by anterior and posterior regions on pre operative MRI can be helpful in predicting development of obesity in patients with CP.
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Affiliation(s)
- Kharisa N Rachmasari
- Dept. of Medicine, New York Presbyterian Hospital - Weill Cornell Medicine, New York, NY, USA
| | - Sara B Strauss
- Dept. of Neuroradiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Joshua Lantos
- Dept. of Neuroradiology, Weill Cornell Medicine, New York, NY, USA
| | - Anjile An
- Div. of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Georgiana A Dobri
- Dept. of Endocrinology, Dept. of Neurosurgery, Weill Cornell Medicine, New York, NY, USA
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