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N. Komoto, A. Kozaki, F. Yu, R. Inoue, T. Maeda, T. Inoue, Y. Inoue; Clinical Feature of Euthyroid Graves’ Ophthalmopathy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5250. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the clinical characteristics of Euthyroid Graves’ ophthalmopathy (EG).
A total of 57 patients with EG (114 eyes, male 14 patients, female 43 patients , mean age of 41.2 years ranging from 15 to 82) were evaluated for proptosis using a Hertel exophthalmometer, height of palpebral fissure, lid swelling, thyroid hormones and antibodies, during the 3-year period between 2004 and 2007. MRI was used to analize the enlargement of the extraocular muscle. A comparison was made between patients of EG and 95 patients (190 eyes, male 13 patients, female 82 patients, mean age of 39.3years) of medically untreated cases of Graves’ ophthalmopathy (GO).
The ratio of female to male among the EG cases was about 3:1 while that among GO cases was about 6:1, with EG tending to be more common in male. Proptosis was an average of 16.9 mm among EG cases, which was significantly higher than the average of 15.3 mm among GO cases (p<0.01). The height of the palpebral fissure was 9.1 mm among EG cases and 8.8 mm among GO cases, and there were no significant differences observed. Among EG cases, lid swelling was 49% and enlargement of the extraocular muscle was 17% for the inferior rectus muscle (IR), 11% for the medial rectus muscle (MR), 10% for the superior rectus muscle (SR), 4% for the lateral rectus muscle (LR) and 16% for the levator palpebrae superioris muscle (Levator), and among GO cases, enlargement of the extraocular muscle was 8% for IR, 7% for MR, 2% for SR, 8% for LR and 8% for Levator. Enlargement of the extraocular muscle was significantly greater among EG cases for the IR, SR and Levator (p<0.05). With respect to hormone levels, TSH was 1.5µIU/ml for EG cases and 0.05µIU/ml for GO cases, FT3 was 3.0pg/ml for EG cases and 19.4pg/ml for GO cases, FT4 was 1.2ng/dl for EG cases and 5.6 ng/dl for GO cases, TRAb was 16.0% for EG cases and 60.5% for GO cases, and TSAb was 249% for EG cases and 1080% for GO cases. Thus, TSH levels were significantly lower, while FT3, FT4, TRAb and TSAb levels were significantly higher in GO cases (p<0.01). With respect to thyroid antibodies, the positive rates for TSAb, TRAb, TPOAb and TgAb were 40%, 30%, 25% and 21%, respectively, and TSAb levels were found to be elevated in the same manner as previous reports. Although thyroid hormone levels were normal in all cases at the time of initial examination, one case required medical treatment for hyperfunction during the course of monitoring.
EG was observed to be more common among male as compared with GO cases, and proptosis and enlargement of extraocular muscle were observed at higher frequencies.
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