Abstract
Purpose :
Thyroid-associated ophthalmopathy (TAO) is most often seen in patients with autoimmune thyroid disease. But thyroid carcinoma with concurrent TAO are rare. The aim of this study was to investigate the clinical characteristics, treatment and prognosis of pre-existing TAO in the patients with thyroid carcinoma.
Methods :
Six thyroid carcinoma patients (40~48 years) presented with ophthalmopathy. All patients received thyroidectomy and/or radioiodine (RAI) with the pathological characteristics of papillary thyroid carcinoma. Levothyroxine substitutive therapy was used after thyroidectomy to keep euthyroid. The activity of TAO was determined by means of the clinical activity score (CAS) and 99mTc-octreotide scintigraphy. All active TAO patients received periocular injection of triamcinolone acetonide (TA, 20mg 3 weeks intervals，5 times total) and support treatment (Selenium Yeast 25μg Bid; Aescuven forte 150mg, Bid). Data were obtained from a follow-up survey. GO-QOL surveys were used in all five patients with TAO.
Results :
All six patients with thyroid carcinoma accompanied with moderate-severe active TAO (CAS≥4). The clinical manifestations of four patients worsened after thyroidectomy and/or RAI treatment. Main symptoms were eyelid retraction (100%), exophthalmos (100%) and restricted ocular motility (80%). Compared with the normative values, obvious enlargement of multi-rectus muscles was involved in all patients. 99mTc-octreotide scintigraphy was positive in all patients and 99mTc-octreotide accumulated intensively in site of rectus muscles involved. Thus, TAO substantially reduced QOL of the patients. After periocular injection of TA, the symptoms of TAO were improved. With the stabilization of ophthalmopathy, CAS and the uptake ration (UR) of 99mTc-octreotide scintigraphy were decreased accordingly in all patients (P<0.05). QOL of the patients with TAO was improved.
Conclusions :
All these middle-aged TAO patients with papillary thyroid carcinoma presented more severe and more active signs compared with middle-aged TAO patients with Graves’ Disease (GD). Prominent extraocular muscles enlargement, rather than expansion of the orbital fat compartment should be the main subtype in all these TAO patients with thyroid carcinoma. Periocular injection of TA was suggested to provide improvement of ophthalmologic symptoms and QOL in thyroid carcinoma patients with TAO.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.