Management of graves myopathy: Thyroid-associated orbitopathy: when should we operate?

J AAPOS

Department of Ophthalmology, California Pacific Medical Center, San Francisco; Department of Ophthalmology, University of California, San Francisco. Electronic address:

Published: August 2018

Thyroid-associated orbitopathy (TAO) is an autoimmune disorder that affects multiple periocular tissues. In TAO, an active immunologic inflammatory phase is typically followed by a cicatrizing recovery phase. Management in the inflammatory phase is supportive, and surgical rehabilitation should generally be deferred until the patient is stable. We review current treatment concepts, with a focus on the timing and sequence of surgical procedures to address proptosis, motility restriction, and eyelid malposition in patients with TAO. A stepwise surgical approach maximizes the predictability of surgical outcomes and minimizes reoperations.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaapos.2017.12.002DOI Listing

Publication Analysis

Top Keywords

thyroid-associated orbitopathy
8
inflammatory phase
8
management graves
4
graves myopathy
4
myopathy thyroid-associated
4
orbitopathy operate?
4
operate? thyroid-associated
4
orbitopathy tao
4
tao autoimmune
4
autoimmune disorder
4

Similar Publications

Background: Plasma from patients with active thyroid-associated orbitopathy (TAO-A) could cause inflammation to fibroblasts, and such a mechanism was explored in the context of melanoma.

Methods: Plasma samples collected from TAO-A patients and healthy control (HC) were primarily co-cultured with the melanoma-associated fibroblasts (MAFs) derived from melanoma patients. The survival and inflammation of the co-cultured MAFs were measured after confirming the levels of pro-inflammatory cytokines.

View Article and Find Full Text PDF

Neural network-based automated proptosis measurement using computed tomography images for patients with thyroid-associated orbitopathy.

Sci Rep

November 2024

Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea.

The purpose of this study was to evaluate the clinical feasibility and reliability of a neural network (NN)-based automated proptosis measurement system using computed tomography (CT) images. An automated proptosis measurement system was developed using the CT images of 200 eyes from 100 patients diagnosed with thyroid-associated orbitopathy. We compared the proptosis value obtained from the proposed automated system with the values obtained from the Hertel exophthalmometer and manual measurements of CT slices.

View Article and Find Full Text PDF
Article Synopsis
  • The study explores the genetic and epigenetic factors involved in the development of Graves' orbitopathy (GO), highlighting that both sex and racial differences indicate a genetic influence on the disease.* -
  • Research shows that while no specific genes have been linked to an increased risk of GO, variations in gene expression and DNA methylation patterns observed in orbital fibroblasts suggest an epigenetic component in its pathogenesis.* -
  • The findings suggest that initial autoimmune triggers may lead to long-lasting changes in gene expression, contributing to the persistence and development of GO, although further examination of histone modifications is needed.*
View Article and Find Full Text PDF

Objectives: The clinical activity score (CAS) and European severity scale (ESS) are established clinical tools to assess thyroid eye disease (TED) but are limited in terms of subjectivity and their reliability in non-Caucasian individuals, and can underestimate significant disease in the posterior orbit. Preliminary data from pilot studies have shown that diffusion-weighted imaging (DWI) using extraocular muscle (EOM) apparent diffusion coefficient (ADC) measurements may provide complementary information in TED. This study expands on previous research to assess for correlations between clinical scores and EOM-ADCs in stratifying disease activity and severity in a large patient cohort from an ethnically diverse population.

View Article and Find Full Text PDF

The authors describe a case of bilateral diffuse paraneoplastic orbital myositis induced by a stage IA left testicular pure seminoma. The patient presented with findings typical of thyroid-associated orbitopathy (TAO) and was thought to have TAO until discovery of the malignancy. Treatment included an urgent orchiectomy, as well as 7 weeks of therapeutic plasma exchange.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!