Lei Chaoyu, Lyu Xukun, Ren Yujie, Wei Dingwei, Zhang Siyuan, Zhang Yuwei, Wang Liu, Liu Libin, Wen Junping, Liu Xiaowei, Lin Chaobin, Lu Wei, Liu Jian, Li Runchuan, Zhang Shuo, Song Xuefei, Yu Zhangsheng, Bahn Rebecca S, Zhou Huifang
State Key Laboratory of Eye Health, Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Thyroid. 2025 Aug 11. doi: 10.1177/10507256251359559.
Thyroid eye disease (TED) is a debilitating autoimmune disorder linked to thyroid dysfunction. There is limited knowledge of TED in Asian populations. This multicenter study characterizes the clinical features and treatment response of TED in a large Chinese cohort. A retrospective multicenter study included 4157 patients with TED from nine Chinese hospitals from February 2016 to July 2023. Disease severity and activity were evaluated according to the European Group on Graves' Orbitopathy standards. We examined associations of variables including sex, age, smoking status, I treatment, consultation department, and geographical region with clinical outcomes. Logistic regression and nomogram models were developed to examine associations with sight-threatening TED and, in a subgroup analysis ( = 126), patients' responsiveness to intravenous glucocorticoid (IVGC) therapy. We included 4157 patients with mean age and standard deviation (SD) 45.96 ± 16.44 years. Of these, 63.6% ( = 2644) were females. Over half (55.6%, = 2310) of participants were in the inactive phase, with a mean clinical activity score of 2.19 ± 1.61 (SD) for all patients. TED severity was categorized as mild (9.3%, = 385), moderate-to-severe (82.5%, = 3428), and sight-threatening (8.2%, = 344). The average degree of exophthalmos was 20.04 ± 5.27 mm, and 48.8% ( = 2029) of patients had diplopia. Patients treated with I had higher disease activity (47.5%, = 468, vs. 43.5%, = 1379, < 0.05). Coastal region patients exhibited more severe TED (sight-threatening cases: 10.1%, = 195, vs. 7.2%, = 147) and higher diplopia scores (1.00 ± 1.10 vs. 0.86 ± 1.09, < 0.001) than inland counterparts. TED severity was also greater in patients treated in Ophthalmology departments (mild cases: 6.0%, = 213; moderate-to-severe cases: 85.6%, = 3055) compared with Endocrinology departments (mild cases: 29.3%, = 172; moderate-to-severe cases: 63.5%, = 373). Nomograms had an area under the receiver operating curve of 0.742 (confidence interval [CI] 0.716-0.768) for sight-threatening TED and 0.759 (CI 0.674-0.843) for IVGC therapy responsiveness. We characterized the clinical features and treatment response of TED in a large Chinese cohort. These findings offer valuable insights informing TED risk stratification in Asian patients and forming a foundation for future prospective studies.
甲状腺眼病（TED）是一种与甲状腺功能障碍相关的使人衰弱的自身免疫性疾病。亚洲人群对TED的了解有限。这项多中心研究描述了中国一个大型队列中TED的临床特征和治疗反应。一项回顾性多中心研究纳入了2016年2月至2023年7月来自中国九家医院的4157例TED患者。根据欧洲Graves眼眶病研究组的标准评估疾病严重程度和活动度。我们研究了性别、年龄、吸烟状况、碘治疗、就诊科室和地理区域等变量与临床结局的关联。建立了逻辑回归和列线图模型来研究与威胁视力的TED的关联，并在亚组分析（n = 126）中研究患者对静脉注射糖皮质激素（IVGC）治疗的反应。我们纳入了4157例患者，平均年龄和标准差（SD）为45.96±16.44岁。其中，63.6%（n = 2644）为女性。超过一半（55.6%，n = 2310）的参与者处于非活动期，所有患者的平均临床活动评分为2.19±1.61（SD）。TED严重程度分为轻度（9.3%，n = 385）、中度至重度（82.5%，n = 3428）和威胁视力（8.2%，n = 344）。平均突眼度为20.04±5.27mm，48.8%（n = 2029）的患者有复视。接受碘治疗的患者疾病活动度更高（47.5%，n = 468，对比43.5%，n = 1379，P<0.05）。沿海地区患者的TED表现更为严重（威胁视力的病例：10.1%，n = 195，对比7.2%，n = 147），复视评分更高（1.00±1.10对比0.86±1.09，P< .001）。与内分泌科相比，眼科治疗的患者TED严重程度也更高（轻度病例：6.0%，n = 213；中度至重度病例：85.6%，n = 3055）（轻度病例：29.3%，n = 172；中度至重度病例：63.5%，n = 373）。列线图对于威胁视力的TED的受试者工作特征曲线下面积为0.742（置信区间[CI] 0.716 - 0.768），对于IVGC治疗反应的曲线下面积为0.759（CI 0.674 - 0.843）。我们描述了中国一个大型队列中TED的临床特征和治疗反应。这些发现为亚洲患者的TED风险分层提供了有价值的见解，并为未来的前瞻性研究奠定了基础。
