Nabi Tauseef, Rafiq Nadeema
Department of Endocrinology, MMSSH, Ambala, Haryana, India.
Department of Physiology, Government Medical College, Baramulla, Jammu and Kashmir, India.
Taiwan J Ophthalmol. 2020 May 4;10(3):197-202. doi: 10.4103/tjo.tjo_10_20. eCollection 2020 Jul-Sep.
Graves' orbitopathy (GO) is one of the most frequent orbital disorders and is the most common cause of proptosis in adults. GO is described as chronic inflammation of orbital and periorbital tissues. This study aimed to evaluate the risk factors for severe GO in patients with Graves' disease (GD).
This was a prospective cross-sectional study done on 52 newly diagnosed patients of GD with GO documented by thyroid Technetium-pertechnetate scan at our center between May 2016 and May 2019. All patients underwent a comprehensive ophthalmological examination and laboratory and hormonal analysis. Clinical Activity Score (CAS) and severity were estimated as per the European Group on Graves Orbitopathy. Thirty-four patients with mild GO were compared with 18 patients with moderate-to-severe GO (severe) for baseline risk parameters.
Majority of the patients had mild orbitopathy (34 [65.4%]) followed by moderate to severe (18 [34.6%]). CAS was active in 13.5% of the study group. There was a statistically significant male preponderance in severe GO. Current smoking increased the risk of severe GO ( = 0.003). Duration of GD symptoms at presentation was statistically significantly longer in severe GO patients than mild GO ( = 0.004). Thyrotropin receptor antibody (TRAb) titer significantly increased in severe GO group (6.2 ± 2.4 IU/L) when compared to mild GO (3.2 ± 1.6 IU/L) ( < 0.001). TRAb positivity was similar between groups. Braley's sign, i.e., the differential intraocular pressure (IOP) of >6 mmHg, was statistically significantly higher in severe GO ( < 0.001). Male gender, current smoking, TRAb >2 upper limit of normal (ULN), and differential IOP >6 mmHg were found to be associated with severe GO.
Approximately 35% of the patients with GO have severe disease, with a higher risk in men. This study identified male gender, current smoking, TRAb >2 ULN, and differential IOP >6 mmHg to be associated with severe GO.
格雷夫斯眼眶病（GO）是最常见的眼眶疾病之一，也是成人眼球突出最常见的原因。GO被描述为眼眶和眶周组织的慢性炎症。本研究旨在评估格雷夫斯病（GD）患者发生严重GO的危险因素。
这是一项前瞻性横断面研究，对2016年5月至2019年5月在我们中心通过甲状腺高锝酸盐扫描确诊为GD且伴有GO的52例新患者进行研究。所有患者均接受了全面的眼科检查以及实验室和激素分析。根据欧洲格雷夫斯眼眶病研究组的标准评估临床活动评分（CAS）和严重程度。将34例轻度GO患者与18例中重度GO（重度）患者的基线风险参数进行比较。
大多数患者患有轻度眼眶病（34例[65.4%]），其次是中重度（18例[34.6%]）。研究组中13.5%的患者CAS呈活跃状态。重度GO患者中男性占优势，差异有统计学意义。当前吸烟会增加发生重度GO的风险（P = 0.003）。重度GO患者出现GD症状的持续时间在统计学上显著长于轻度GO患者（P = 0.004）。与轻度GO患者（3.2±1.6 IU/L）相比，重度GO组促甲状腺素受体抗体（TRAb）滴度显著升高（6.2±2.4 IU/L）（P < 0.001）。两组之间TRAb阳性率相似。重度GO患者中布雷利征（即眼压差>6 mmHg）在统计学上显著更高（P < 0.001）。发现男性、当前吸烟、TRAb>2倍正常上限（ULN）以及眼压差>6 mmHg与重度GO相关。
约35%的GO患者患有严重疾病，男性风险更高。本研究确定男性、当前吸烟、TRAb>2 ULN以及眼压差>6 mmHg与重度GO相关。
