Lai Kenneth Ka Hei, Aljufairi Fatema Mohamed Ali Abdulla, Sebastian Jake Uy, Lai Kei Hei, Chan Karen Kar Wun, Chin Joyce Kar Yee, Chan Regine Yien Ching, Li Chi Lai, Yip Wilson Wai Kuen, Young Alvin Lerrmann, Tham Clement Chee Yung, Pang Chi Pui, Chong Kelvin Kam Lung
Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, Hong Kong.
Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
Br J Ophthalmol. 2025 May 30;109(6):715-720. doi: 10.1136/bjo-2024-325346.
To report the presenting clinical, serological and treatment profiles of 1439 patients with thyroid eye disease (TED) from a tertiary centre in Hong Kong.
Consecutive patients with TED presented to the Thyroid Eye Clinic (TEC), the Chinese University of Hong Kong between 2014 and 2023.
Prospective cohort and masked review of medical records and orbital images.
A total of 1439 (70% female, 98% Han Chinese) patients with TED (26% ex/current smoker), presented at 43±5.9 years old, were reviewed. The first TED symptoms to TEC evaluation was 6±3 months. 85% had Graves' disease and 12% were given radioactive iodine before presentation. 35% of patients had a family history of autoimmune thyroid diseases. Baseline thyroid-stimulating hormone receptor antibody, thyroid-stimulating immunoglobulin and thyroid peroxidase antibody were elevated in 75%, 69% and 57% tested. Euthyroid TED (E-TED) was diagnosed in 6%, associated with asymmetric presentation (p<0.001). The most common signs were exophthalmos (69%), upper eyelid retraction (53%), swelling (36%), conjunctival injection (34%) and lower eyelid retraction (32%). Notably, 547 (38%) presented with moderate-to-severe and 150 (10%) vision-threatening TED, whose clinical activity score (CAS) was just 2.4±1.4 and 2.6±1.5, respectively. Male and TED onset after 40 were associated with higher CAS and NOSPEC (No physical signs or symptoms, Only signs, Soft tissue involvement, Proptosis, Extraocular muscle signs, Corneal involvement, and Sight loss) score (both p<0.05). 471 (33%), 361 (25%), 263 (18%) and 138 (9%) patients received intravenous methylprednisolone, orbital radiotherapy, steroid-sparing immunosuppressants and surgical decompression, respectively.
Around one-third (34%) of our cohort presented with 'low-CAS, progressive', moderate-to-severe or vision-threatening TED, while only one-fifth (18%) were clinically active (CAS≥3). Our results showed the limitations and unmet need of the existing 'high-CAS only' approach, especially in managing 'non-inflammatory' TED, prevalent in non-Caucasian populations.
报告来自香港一家三级医疗中心的1439例甲状腺眼病（TED）患者的临床、血清学及治疗情况。
2014年至2023年间连续就诊于香港中文大学甲状腺眼科诊所（TEC）的TED患者。
前瞻性队列研究及对病历和眼眶图像进行盲法评估。
共纳入1439例TED患者（70%为女性，98%为汉族），平均年龄43±5.9岁，其中26%为既往/当前吸烟者。首次出现TED症状至TEC评估的时间为6±3个月。85%的患者患有格雷夫斯病，12%患者在就诊前接受过放射性碘治疗。35%的患者有自身免疫性甲状腺疾病家族史。检测的患者中，75%的促甲状腺素受体抗体、69%的促甲状腺素免疫球蛋白和57%的甲状腺过氧化物酶抗体基线水平升高。6%的患者被诊断为甲功正常的TED（E-TED），与不对称表现相关（p<0.001）。最常见的体征为眼球突出（占69%）、上睑退缩（占53%）、肿胀（占36%）、结膜充血（占34%）和下睑退缩（占32%）。值得注意的是，547例（38%）患者表现为中重度TED，150例（10%）患者表现为威胁视力的TED，其临床活动评分（CAS）分别仅为2.4±1.4和2.6±1.5。男性及40岁后发病的TED患者与较高的CAS及NOSPEC（无体征或症状、仅有体征、软组织受累、眼球突出、眼外肌体征、角膜受累及视力丧失）评分相关（p均<0.05）。分别有471例（33%）、361例（25%）、263例（18%）和138例（9%）患者接受了静脉注射甲泼尼龙、眼眶放疗、类固醇替代免疫抑制剂及手术减压治疗。
在我们的队列中，约三分之一（34%）的患者表现为“低CAS、进行性”的中重度或威胁视力的TED，而只有五分之一（18%）的患者临床活动度较高（CAS≥3）。我们的结果显示了现有“仅高CAS”方法的局限性及未满足的需求；尤其是在管理非白种人群中普遍存在的“非炎症性”TED方面。
