Asymmetric Graves' Orbitopathy

Overview

Journal Front Endocrinol (Lausanne)

Specialty Endocrinology

Date 2021 Jan 4

PMID 33391188

Citations 12

Authors

Grigorios Panagiotou

Petros Perros

Affiliations

Soon will be listed here.

Abstract

Graves' Orbitopathy (GO) is an autoimmune orbital disorder usually presenting as a sequala of autoimmune thyroid disease. The presence of GO is associated with increased psychological burden and, in severe cases may cause blindness. While most patients with GO present with bilateral disease, asymmetric or unilateral GO may affect a significant proportion of patients diagnosed with GO. Older age, male sex, active and severe disease correlate with asymmetric disease. However, the exact mechanisms causing asymmetry remain elusive. Herein, we review the literature on asymmetric GO and highlight its differences compared with bilateral GO.

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References

Shah S, Joshi M . An assessment of asymmetry in the normal craniofacial complex. Angle Orthod. 1978; 48(2):141-8. DOI: 10.1043/0003-3219(1978)048<0141:AAOAIT>2.0.CO;2. View

Douglas R, Kahaly G, Patel A, Sile S, Thompson E, Perdok R . Teprotumumab for the Treatment of Active Thyroid Eye Disease. N Engl J Med. 2020; 382(4):341-352. DOI: 10.1056/NEJMoa1910434. View

Ferlov-Schwensen C, Brix T, Hegedus L . Death by Suicide in Graves' Disease and Graves' Orbitopathy: A Nationwide Danish Register Study. Thyroid. 2017; 27(12):1475-1480. DOI: 10.1089/thy.2017.0365. View

Salvi M, Vannucchi G, Campi I, Rossi S, Bonara P, Sbrozzi F . Efficacy of rituximab treatment for thyroid-associated ophthalmopathy as a result of intraorbital B-cell depletion in one patient unresponsive to steroid immunosuppression. Eur J Endocrinol. 2006; 154(4):511-7. DOI: 10.1530/eje.1.02119. View

Shyu V, Hsu C, Chen C, Chen C . 3D-assisted quantitative assessment of orbital volume using an open-source software platform in a Taiwanese population. PLoS One. 2015; 10(3):e0119589. PMC: 4361687. DOI: 10.1371/journal.pone.0119589. View

Eckstein A, Losch C, Glowacka D, Schott M, Mann K, Esser J . Euthyroid and primarily hypothyroid patients develop milder and significantly more asymmetrical Graves ophthalmopathy. Br J Ophthalmol. 2009; 93(8):1052-6. DOI: 10.1136/bjo.2007.137265. View

Marcocci C, Kahaly G, Krassas G, Bartalena L, Prummel M, Stahl M . Selenium and the course of mild Graves' orbitopathy. N Engl J Med. 2011; 364(20):1920-31. DOI: 10.1056/NEJMoa1012985. View

Perros P, Zarkovic M, Panagiotou G, Azzolini C, Ayvaz G, Baldeschi L . Asymmetry indicates more severe and active disease in Graves' orbitopathy: results from a prospective cross-sectional multicentre study. J Endocrinol Invest. 2020; 43(12):1717-1722. PMC: 7652741. DOI: 10.1007/s40618-020-01258-w. View

Jang S, Lee S, Lee E, Yoon J . Clinical features of thyroid-associated ophthalmopathy in clinically euthyroid Korean patients. Eye (Lond). 2012; 26(9):1263-9. PMC: 3443838. DOI: 10.1038/eye.2012.132. View

10.

Kashkouli M, Nojomi M, Parvaresh M, Soltan Sanjari M, Modarres M, Noorani M . Normal values of hertel exophthalmometry in children, teenagers, and adults from Tehran, Iran. Optom Vis Sci. 2008; 85(10):1012-7. DOI: 10.1097/OPX.0b013e3181890dc7. View

11.

Chebib F, Chamma A . Indices of craniofacial asymmetry. Angle Orthod. 1981; 51(3):214-26. DOI: 10.1043/0003-3219(1981)051<0214:IOCA>2.0.CO;2. View

12.

Ponto K, Binder H, Diana T, Matheis N, Otto A, Pitz S . Prevalence, Phenotype, and Psychosocial Well-Being in Euthyroid/Hypothyroid Thyroid-Associated Orbitopathy. Thyroid. 2015; 25(8):942-8. DOI: 10.1089/thy.2015.0031. View

13.

Soroudi A, Goldberg R, McCann J . Prevalence of asymmetric exophthalmos in Graves orbitopathy. Ophthalmic Plast Reconstr Surg. 2004; 20(3):224-5. DOI: 10.1097/01.iop.0000124675.80763.5a. View

14.

Ye X, Bo X, Hu X, Cui H, Lu B, Shao J . Efficacy and safety of mycophenolate mofetil in patients with active moderate-to-severe Graves' orbitopathy. Clin Endocrinol (Oxf). 2016; 86(2):247-255. DOI: 10.1111/cen.13170. View

15.

Kavoussi S, Giacometti J, Servat J, Levin F . The relationship between sex and symmetry in thyroid eye disease. Clin Ophthalmol. 2014; 8:1295-300. PMC: 4096447. DOI: 10.2147/OPTH.S61041. View

16.

Sheikh M, Abalkhail S, Doi S, Al-Shoumer K . Normal measurement of orbital structures: implications for the assessment of Graves' ophthalmopathy. Australas Radiol. 2007; 51(3):253-6. DOI: 10.1111/j.1440-1673.2007.01721.x. View

17.

Abraham-Nordling M, Bystrom K, Torring O, Lantz M, Berg G, Calissendorff J . Incidence of hyperthyroidism in Sweden. Eur J Endocrinol. 2011; 165(6):899-905. DOI: 10.1530/EJE-11-0548. View

18.

Wiersinga W, Bleumink M, Saeed P, Baldeschi L, Prummel M . Is sleeping position related to asymmetry in bilateral Graves' ophthalmopathy?. Thyroid. 2008; 18(5):541-4. DOI: 10.1089/thy.2007.0302. View

19.

Prummel M, Bakker A, Wiersinga W, Baldeschi L, Mourits M, Kendall-Taylor P . Multi-center study on the characteristics and treatment strategies of patients with Graves' orbitopathy: the first European Group on Graves' Orbitopathy experience. Eur J Endocrinol. 2003; 148(5):491-5. DOI: 10.1530/eje.0.1480491. View

20.

Kashkouli M, Kaghazkanani R, Heidari I, Ketabi N, Jam S, Azarnia S . Bilateral versus unilateral thyroid eye disease. Indian J Ophthalmol. 2011; 59(5):363-6. PMC: 3159317. DOI: 10.4103/0301-4738.83612. View