Abstract
Purpose :
Thyroid-associated ophthalmopathy (TAO) is most often seen in middle-aged patients with autoimmune thyroid disease, and immunosuppression is optimal therapy for active TAO. In elderly patients, TAO is less frequent but more severe. In this study, we aimed to determine the clinical characteristics and therapeutic schedule in elderly patients with TAO.
Methods :
This retrospective study comprised 106 elderly patients with TAO (65.24±4.90 years). Data were obtained from a follow-up survey. The patients with active TAO received intravenous injection of methylprednisolone (MP) (39 cases), or periocular injection of triamcinolone acetonide (TA) (16 cases),or TA+oral cyclosporine A (TA+CsA) (35 cases). The NOSPECS classification, the clinical activity score (CAS) and 99mTc-octreotide scintigraphy were used to evaluation of severity and activity of TAO before and after treatment.
Results :
106 elderly patients with TAO were identified (61 male, 45 female). At the time of initial diagnosis, 74.53% of the patients were hyperthyroid. 95.28% of the patients had bilateral TAO. Main symptoms were eyelid swelling (79.25%), exophthalmos (79.25%), eye movement limitation (81.13%) and double vision (75.47%). 12.26% of the patients had optic neurophathy. Orbital CT showed 86.79% of the patients had enlarged extraocular muscles. The exophthalmos, CAS score and NOSPECS grades of the patients with thyroid dysfunction were significantly higher than those with normal thyroid function (P<0.05). 99mTc-octreotide scintigraphy was positive in active TAO patients (95%) with elevated uptake ratio (UR) (P<0.05). Smoking showed a significant correlation with CAS score (P<0.05), and age correlated with NOSPECS grade (P<0.05). Both UR and CAS scores of 90 patients with moderate to severe active TAO decreased significantly after treatment (P<0.05). The response rates of MP group and TA+CsA group were significantly higher than TA group (P<0.05), and with no significant difference (P>0.05).
Conclusions :
The clinical manifestations of elderly patients with TAO were usually severe. Exophthalmos and eye movement limitation were the most common features and bilateral involvement. Thyroid dysfunction, smoking and age may increase the activity and severity of TAO. Intravenous corticosteroid pulse therapy and periocular injection of triamcinolone acetonide combined with cyclosporine A are effective for moderate to severe active TAO in elderly patients.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.