International Journal of Ophthalmology & Visual Science

Research Article | | Peer-Reviewed |

Determinants of Favourable Outcome Among Adults with Active Thyroid Eye Disease: The Remarkable Role of Long-Duration Treatment Approaches

Received: 27 December 2023    Accepted: 9 January 2024    Published: 18 January 2024
Views:       Downloads:

Share This Article

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) < 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.

DOI 10.11648/j.ijovs.20240901.11
Published in International Journal of Ophthalmology & Visual Science (Volume 9, Issue 1, April 2024)
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

Keywords

Thyroid Orbitopathy, Thyroid-Associated Ophthalmopathy, Graves’ Disease, Thyroid-Eye-Disease, Outcome Determinants, Duration of Treatment

References
[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
Cite This Article
  • 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

    Copy | Download

    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

    Copy | Download

    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

    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}
    }
    

    Copy | Download

  • 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  - 

    Copy | Download

Author Information
  • 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

  • Sections