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Graves orbitopathy

Marius N Stan, Mario Salvi
Rituximab (RTX) use in open label series has been associated with very encouraging responses in patients with active and moderate-to-severe Graves' Orbitopathy (GO). Recently randomized controlled trials of RTX have been performed in such patients in order to answer the question of clinical efficacy and the safety profile of this agent. That data, reported separately, focused on Clinical Activity Score (CAS) and indicated in one trial a strong benefit of RTX in comparison with IV glucocorticoids while the other trial noted the absence of a benefit by comparison with placebo...
October 19, 2016: European Journal of Endocrinology
S Sellari-Franceschini, I Dallan, A Bajraktari, G Fiacchini, M Nardi, R Rocchi, C Marcocci, M Marinò, A P Casani
The objective of this study is to analyse the complications of orbital decompression in Graves' orbitopathy. The clinical records of 946 patients who had been operated on with orbital decompression for Graves' orbitopathy were reviewed and the intra- and post-operative complications with minimum follow-up of six months were analysed. An extensive review of the literature was carried out to compare results. In the case-series reported here the most frequent complications were: wasting of the temporal region (100%) in patients operated on using a coronal approach; permanent hypoesthesia of V2 (13%) and V1 (8%) in patients operated on with an upper eyelid incision...
August 2016: Acta Otorhinolaryngologica Italica
Zdeněk Fryšák, David Karásek, Milan Halenka
Endocrine orbitopathy (EO) must be understood mainly as a result of oxidative stress. The pathological process finally affects both the appearance and vision of the patient. In the case of inappropriate or late treatment or lack of patient cooperation, it significantly influences the quality of life of those affected. In spite of the sophisticated dia-gnostic algorithms, in some cases it is difficult to confirm the diagnosis of EO. The range of laboratory methods, the essential part of the diagnostic process, has only recently been extended by the possibility of quantification of specific, stimulating immunoglobulins (TSI)...
2016: Vnitr̆ní Lékar̆ství
Marenza Leo, Teresa Mautone, Ilaria Ionni, Maria Antonietta Profilo, Elena Sabini, Francesca Menconi, Barbara Mazzi, Roberto Rocchi, Francesco Latrofa, Marco Nardi, Paolo Vitti, Claudio Marcocci, Michele Marinò
OBJECTIVE: Intravenous (iv) glucocorticoids (GC) (ivGC) are used for active Graves orbitopathy (GO), but factors affecting GO outcome are poorly understood. We performed a retrospective study to investigate the variables affecting GO after ivGC. METHODS: We evaluated 83 consecutive GO patients treated with ivGC but not orbital radiotherapy (ORT) and re-examined them after a median of 47 months. The endpoints were the relationships between GO outcome or additional treatments with age, sex, smoking habits, thyroid volume, thyroid treatment, time since thyroid treatment, antithyroid-stimulating hormone receptor antibodies (TRAb), GO duration, GO features, and follow-up time...
October 2016: Endocrine Practice
Andrea Papp, Clemence Vasserot-Merle, Guido Dorner, Dion Paridaens
This article reports on two cases of severe pediatric Graves orbitopathy (GO) in two adolescents of African origin. Two black male adolescents presented with highly active GO and signs of beginning compressive optic neuropathy. Neither of them were smokers nor had a family history of GO. Besides urgent referral to pediatric endocrinologists, intravenous methylprednisolon pulse therapy was initiated. In spite of the fluctuating thyroid hormone levels in the initial phase of antithyroid therapy, intravenous steroid administration stopped the progression of malignant GO rapidly in both of our patients without any considerable side effects...
August 12, 2016: Orbit
Francesca Menconi, Marenza Leo, Elena Sabini, Teresa Mautone, Marco Nardi, Aldo Sainato, Stefano Sellari-Franceschini, Paolo Vitti, Claudio Marcocci, Michele Marinò
Intravenous glucocorticoids are used for Graves' orbitopathy, alone or associated with/followed by additional treatments (orbital radiotherapy, orbital decompression, palpebral or eye surgery). However, the relation between associated/additional treatments and other variables with Graves' orbitopathy outcome following intravenous glucocorticoids is not clear. Thus, the present study was conducted to investigate retrospectively the impact of associated/additional treatments and other variables on Graves' orbitopathy outcome after intravenous glucocorticoids...
October 5, 2016: Endocrine
Justyna Szczapa-Jagustyn, Anna Gotz-Więckowska, Jarosław Kocięcki
BACKGROUND: Risk of developing thyroid-associated ophthalmopathy (TAO) in children and adolescents is similar or may be even slightly higher than in adults. The aim of this article is to review and summarize current knowledge regarding diagnostic and therapeutic measures in pediatric TAO. CONTENT: MEDLINE and EMBASE papers were searched using the terms 'pediatric Graves' ophthalmopathy' 'pediatric Graves' orbitopathy', 'thyroid-associated ophthalmopathy in childhood and adolescence' from the year 1970 to December 2015...
October 1, 2016: Journal of Pediatric Endocrinology & Metabolism: JPEM
P Anagnostis, K Boboridis, F Adamidou, M Kita
BACKGROUND/AIMS: The natural course of Graves' orbitopathy (GO) has been poorly documented. The aim of this review is to provide current knowledge regarding the natural course of mild GO, trying to address the issue of whether and to what extent it constitutes a chronic remitting or transient disease. METHODS: We systematically searched PubMed for English language publications until August 2016 under the following terms: "Graves' orbitopathy" OR "Graves' ophthalmopathy" OR "thyroid eye disease" AND "natural course" OR "natural history"...
September 23, 2016: Journal of Endocrinological Investigation
Edyta Pawlak-Adamska, Irena Frydecka, Marek Bolanowski, Anna Tomkiewicz, Anna Jonkisz, Lidia Karabon, Anna Partyka, Oskar Nowak, Marek Szalinski, Jacek Daroszewski
Graves' disease, an autoimmune disease with heterogeneous symptoms including Graves' orbitopathy, has a combined genetic/environmental background, where variations within CD28/CTLA-4/ICOS genes are considered as disease markers.Association of CD28c.17+3T>C(rs3116496), CTLA-4g.319C>T(rs5742909), CTLA-4c.49A>G(rs231775), CTLA-4g.*642AT(8_33), CT60(rs3087243), Jo31(rs11571302), ICOSc.1554+4GT(8_15) polymorphisms with susceptibility to Graves' disease and clinical outcome was investigated. The study group comprised of 561 Polish Caucasians, including 172 unrelated Graves' disease patients...
September 16, 2016: Endocrine
Ji Won Kim, Young Jun Woo, Jin Sook Yoon
The aim of this study is to describe characteristics of Graves' orbitopathy (GO) patients with progressive diplopia and to consider whether modified clinical activity score (CAS) is a useful indicator for prediction of diplopia progression. Medical records and images of GO patients with progressive diplopia were retrospectively reviewed. Clinical parameters (e.g., modified CAS, modified NOSPECS score, exophthalmometry results, score of diplopia, and prevalence of optic neuropathy) were evaluated. Thyroid stimulating hormone receptor autoantibody (TRAb) values were determined...
September 13, 2016: Endocrine Journal
Ira Seibel, Veit Maria Hofmann, Hasibe Sönmez, Shideh Schönfeld, Masen Dirk Jumah, Minoo Lenarz, Annekatrin Coordes
OBJECTIVE: Graves' Orbitopathy (GO) has well established treatment guidelines; however, its management is still controversial. The aim was to evaluate the results of medial and mediolateral orbital decompression (OD) in intractable GO. METHODS: Retrospective chart review of all patients with advanced stages of GO, who underwent medial (1-wall) or mediolateral (2-wall) OD between May 2012 and November 2014 in our institution. Ophthalmologic examinations included visual acuity, Hertel exophthalmometry (proptosis), intraocular pressure (IOP), visual field (30:2) and diplopia...
September 5, 2016: Auris, Nasus, Larynx
Gina-Eva Görtz, Sajad Moshkelgosha, Christoph Jesenek, Bärbel Edelmann, Mareike Horstmann, J Paul Banga, Anja Eckstein, Utta Berchner-Pfannschmidt
A mouse model of Graves' orbitopathy (GO) induced by genetic immunization of human TSH receptor (TSHR) A-subunit encoding plasmid has recently been established. The orbital pathology was characterized by adipogenesis, myopathy and fibrosis. Human orbital fibroblasts (OFs) express TSHR and IGF-1 receptor (IGF-1R) and are considered to be pathogenic in GO. We established conditions for growing ex vivo cultures of mouse OFs (mOFs) from orbital tissue of animals undergoing GO and controls. Early passage mOFs showed characteristic fibroblast morphology and expressed mesenchymal stem cell markers including a strong expression of CD90...
October 2016: Endocrinology
Ji Won Kim, Ka Hyun Lee, Young Jun Woo, Jinna Kim, Ki Chang Keum, Jin Sook Yoon
PURPOSE: To evaluate the effect of orbital radiation prior to surgery on the clinical course and extraocular muscle (EOM) radiologic volume changes after decompression in Graves' orbitopathy (GO). DESIGN: Retrospective, interventional case series METHODS: The medical records of patients treated with orbital decompression for GO and who underwent postoperative orbital computed tomography were reviewed. Only patients who underwent rehabilitative decompression in the inactive phase and who received systemic corticosteroids alone (ST group) or combined orbital radiation and systemic corticosteroids (SRT group) in the active inflammatory phase of the disease were selected...
August 16, 2016: American Journal of Ophthalmology
Agata Czarnywojtek, Krzesisława Komar-Rychlicka, Małgorzata Zgorzalewicz-Stachowiak, Nadia Sawicka-Gutaj, Kosma Woliński, Paweł Gut, Maria Płazinska, Barbara Torlińska, Ewa Florek, Joanna Waligórska-Stachura, Marek Ruchała
INTRODUCTION    Graves' Orbitopathy (GO) is an autoimmune disease associated with Graves' disease. Therapy is largely dependent on the severity and activity of ocular changes. Particular attention should be given to radioiodine therapy (RIT). Although its application is a valuable method of the treatment of hyperthyroidism, it may be followed by worsening of GO. OBJECTIVES    The aim of the present article is to indicate how the severity of nicotine addiction influences the response for RAI treatment in GO patients...
August 18, 2016: Polskie Archiwum Medycyny Wewnętrznej
Douglas S Ross, Henry B Burch, David S Cooper, M Carol Greenlee, Peter Laurberg, Ana Luiza Maia, Scott A Rivkees, Mary Samuels, Julie Ann Sosa, Marius N Stan, Martin A Walter
BACKGROUND: Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. METHODS: The American Thyroid Association (ATA) previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011...
October 2016: Thyroid: Official Journal of the American Thyroid Association
Jung Woo Byun, Sena Hwang, Chan Woo Kang, Jin Hee Kim, Min Kyung Chae, Jin Sook Yoon, Eun Jig Lee
PURPOSE: Protocatechuic aldehyde (3,4-dihydroxybenzaldehyde; PCA) is extracted from Salvia miltiorrhiza, and has been reported to possess antiproliferative, antioxidant, and antiadipogenesis properties in various in vivo and in vitro experiments. This study aimed to outline the antioxidant and suppressive effects of PCA on adipogenesis and hyaluronan production in orbital fibroblasts to help with designing therapeutic approaches for Graves' orbitopathy (GO). METHODS: We assessed the in vitro effects of PCA on orbital fibroblasts, which were cultured from orbital fat tissue obtained from patients undergoing orbital decompression for severe GO...
August 1, 2016: Investigative Ophthalmology & Visual Science
Sun Young Jang, Min Kyung Chae, Joon H Lee, Eun Jig Lee, Jin Sook Yoon
PURPOSE: To investigate the role of microRNA 146a (miR-146a) in the regulation of inflammation in an in vitro model of Graves' orbitopathy (GO). METHODS: The level of miR-146a expression in orbital adipose tissue was compared between GO and non-GO by quantitative real-time PCR (qPCR). The effects of interleukin 1β (IL-1β) on miR-146a expression were analyzed in orbital fibroblasts by qPCR. To investigate the molecular mechanism underlying IL-1β-induced miR-146a expression, the effects of inhibitors of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), mitogen-activated protein kinase/extracellular signal-regulated kinases (MEK)-1/2, c-Jun N-terminal kinases (JNK)-1/2, p38 MAP kinase, and phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K) were analyzed...
August 1, 2016: Investigative Ophthalmology & Visual Science
Roberto Negro, Roberto Attanasio, Franco Grimaldi, Rinaldo Guglielmi, Enrico Papini
BACKGROUND: Patients suffering from Graves' disease (GD) are quite frequent in endocrine clinical practice. In particular, overt hyperthyroidism may be complicated by serious adverse events and requires careful treatment, but its management has changed over the years in both the USA and European Union (EU). OBJECTIVES: To evaluate the current diagnosis and management of patient's with GD in Italy, and compare results with those obtained in previous similar surveys in the USA and EU...
July 2016: European Thyroid Journal
Murat Faik Erdoğan, Özgür Demir, Reyhan Ünlü Ersoy, Kamile Gül, Berna İmge Aydoğan, Ziynet Alphan Üç, Türkan Mete, Sibel Ertek, Uğur Ünlütürk, Bekir Çakır, Yalçın Aral, Serdar Güler, Sevim Güllü, Demet Çorapçıoğlu, Selçuk Dağdelen, Gürbüz Erdoğan
BACKGROUND: The optimal therapeutic choice for Graves' hyperthyroidism in the presence of moderate-severe Graves' orbitopathy (GO) remains controversial. OBJECTIVES: We aimed to compare GO course in patients with moderate-severe GO treated with early total thyroidectomy (TTx) versus antithyroid drug (ATD) regimens, in a prospective, randomized manner. METHODS: Forty-two patients with moderate-severe GO were enrolled. A total of 4.5 g of pulse corticosteroids were given intravenously to all patients before randomization...
July 2016: European Thyroid Journal
Xiaozhen Ye, Xiaoyong Bo, Xiaohao Hu, Huanhuan Cui, Bin Lu, Jiaqing Shao, Jian Wang
CONTEXT: Graves' orbitopathy (GO) is a potentially sight-threatening disease for which currently available medical therapy is not reliably successful. Mycophenolate mofetil (MMF) is a selective immunosuppressant used widely in many autoimmune diseases. Preliminary studies have shown that MMF is effective in the treatment of active GO. OBJECTIVE: To evaluate the efficacy and safety of MMF in patients with active moderate-to-severe GO. PATIENTS: One hundred and 74 patients with active moderate-to-severe GO were randomized to receive either MMF or glucocorticoids (GC)...
August 3, 2016: Clinical Endocrinology
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