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Top photos show a patient with unilateral thyroid optic neuropathy and coronal and axial computerized tomography (CT) scan demonstrating an apical crowding. Middle photos show a patient with unilateral thyroid extra-ocular myopathy and coronal CT scan demonstrating muscles’ enlargement. Bottom photos show a patient with unilateral thyroid eyelid retraction
Source publication
The aim of this study was to compare demographics, clinical manifestations, associated systemic and ocular factors, severity and activity of patients with unilateral thyroid eye disease (U-TED) versus bilateral thyroid eye disease (B-TED).
In a cross-sectional study, all patients with Graves' hyperthyroidism and primary hypothyroidism seen in an en...
Context in source publication
Context 1
... mean age, associated systemic diseases, severity and activity scores in monovariate analysis [ Table 1] were re- analyzed. However, a multivariate binary regression analysis of the signifi cant variables showed that none of them was independently signifi cant between the two groups (0.9<P<1). Patients with U-TED showed different severity of TED [ Fig. ...Citations
... Graves' orbitopathy is an immune-mediated process that expands fibroblast in the extraocular 34 muscles within the constrained space of the bony orbits in patients with Graves' disease. 1 On physical examination, he had tachycardia (114 beats/ minute), blood pressure of (120/78), 63 respiratory rate was18 breaths/ minute, and oxygen saturation was 99% in ambient air. He was 64 not restless and had no tremors. ...
Thyroid eye disease (TED) is the most common symptoms of Graves’ disease. This condition commonly manifests bilaterally and symmetrically. The most prominent symptoms are lid retraction, exophthalmos, and diplopia. Rarely, individuals with Graves’ disease may show asymmetrical or unilateral eye symptoms. Marine-Lenhart syndrome is a variant of Graves’ disease with occasional hyperactive nodules. We introduce a 36-year-old Omani male patient who presented to the endocrinology outpatient department of Sultan Qaboos University Hospital, Muscat, Oman, in 2022 with unilateral eye proptosis and was subsequently found to have Graves’ disease. This case presents a rare Graves’ disease variant with unilateral goiter and orbitopathy. Keywords: Graves’ disease; Unilateral proptosis; Thyroid Eye Disease; Graves ’orbitopathy; Marine-Lenhart syndrome.
... Continuous unilateral involvement can occur. Although this is not always the case, there is evidence to suggest that a disease that at first seems to be affecting just one side may really affect both sides (Kashkouli et al., 2011). This study aimed to provide information about TED patient profiles based on sex, age, clinical features, TED laterality, thyroid status, and the correlation between the laterality of TED patients with their thyroid status. ...
Introduction: Thyroid eye disease (TED), an autoimmune thyroid disorder, is prevalent in Asian countries and exhibits a variety of manifestations. Orbital involvement in TED is usually bilateral but may occur unilaterally in some cases. While it is commonly associated with hyperthyroidism, it also manifests in individuals with hypothyroidism or euthyroidism. The purpose of this study was to investigate the relationship between TED laterality and thyroid status in TED patients treated at the Eye Oncology Clinic of Dr. Soetomo General Academic Hospital in Surabaya, Indonesia.Methods: The study was retrospective, analytical and observational. Patients diagnosed with TED who were treated at Dr. Soetomo General Academic Hospital between January 2019 and December 2021 were the focus of this study. SPSS analyses of medical records that satisfied the sample criteria were used to compile the data for this study.Results: There were 88 samples that were dominated by females (57.95%) and aged 41 – 50 (32.96%). Proptosis was the most common clinical manifestation (94.32%), with compressive optic neuropathy was the least common (3,41%). Eyelid retraction occurred in only 22.7% of the patients. TED was categorized into unilateral (44.32%) and bilateral (50%). The majority had hyperthyroidism (70.45%), followed by euthyroidism (25%), and hypothyroidism (4.55%). It was found that there was a significant correlation between thyroid status and TED laterality. Compared to euthyroidism, abnormal thyroid conditions such as hyperthyroidism and hypothyroidism develop bilateral TED more frequently than normal thyroid conditions.Conclusion: There was a correlation between TED laterality and thyroid status among patient TED.
... The authors think that this could be due to the fact that most TED cases at our center are diagnosed clinically due to financial constraints and overall health system of the Philippines. It is known that the disease is prevalently asymmetric in presentation [15], thus the contralateral side may look more normal than the more severe sidemaking an error in diagnosis is likely. With current improvements and more access to better imaging, this may be rectified in the future. ...
Risk factors and disease characteristics of TED cases at EAMC coincide with local published journals, except for significant correlation with male sex and TRAb titers showing the variability of the disease and the need for further studies.
... Moderate-severe forms account for 5%-6% of all cases. 27,28 The diseases often occur bilaterally. Unilateral orbitopathy can be seen in 9%-15% of Graves' patients. ...
Marine-Lenhart syndrome is a name given to the coexistence of Graves' disease and functional nodules. In this rare syndrome, nodules are mostly benign. The most common extrathyroidal manifestation of Graves' disease is Graves' orbitopathy. It is usually seen bilaterally but can also be seen unilaterally. In this article, a case with Marine-Lenhart syndrome, metastatic thyroid papillary carcinoma, and unilateral Graves' orbitopathy is presented.
... A similar result was reported for the northern population of Iran, yet in another study, activity was reported in 28.9% of the patients in the capital of Iran. 17,28 In one study in Africa, a similar severity rate was seen. 27 In an Indian study, only 3% were active, with 83% of patients categorized as mild. ...
Purpose:
To focus on clinical manifestations and epidemiology of thyroid eye disease (TED) in Central Iran's population.
Methods:
In this retrospective case study, we analyzed all patients with TED who were referred to our oculoplastic clinic from 2015 to 2019. The patients' epidemiological characteristics and clinical presentation were compared between different thyroid disease groups and genders.
Results:
Overall, 383 patients (155 male; 40.5% and 228 female; 59.5%) were included. The mean age was 39.55 years (standard deviation ± 13.45, range 10-72). Most patients (89%) were hyperthyroid with the highest duration of ocular involvement among all categories (25.6 months). The most common signs on ophthalmic examinations were proptosis (80.4%), followed by eyelid retraction (72.3.0%). TED was classified as mild in 24.5%, moderate to severe in 67.6%, and sight-threatening in 7.9%. Thirty patients (7.8%) had active TED.
Conclusions:
This series with a relatively more significant number of TED cases in Central Iran found similar epidemiological and clinical characteristics of TED compared to other studies from Iran. Most of our patients were hyperthyroid, with more females compared to males. Proptosis and eyelid retraction were the most common manifestations. Most TED patients were classified as moderate to severe.
... An earlier study published by Kashkouli and colleagues investigated whether there was in fact a possibility that either laterality types was related to a more severe and active form of TED. 11 From 851 patients, 303 of which had TED (32 with unilateral TED; 10.6%), the study found that laterality of TED was not associated with either a more severe form of TED or active TED. 11 Stemming from the study by Kashkouli and colleagues it was our aim to investigate differences in sociodemographic factors, medical history, presentation, severity of TED, and rates of TED activity between unilateral TED and bilateral TED in the Philippines. ...
... 11 From 851 patients, 303 of which had TED (32 with unilateral TED; 10.6%), the study found that laterality of TED was not associated with either a more severe form of TED or active TED. 11 Stemming from the study by Kashkouli and colleagues it was our aim to investigate differences in sociodemographic factors, medical history, presentation, severity of TED, and rates of TED activity between unilateral TED and bilateral TED in the Philippines. Furthermore, the study by Kashkouli and colleagues was completed in 2006. ...
... 18 An even higher difference between unilateral and bilateral TED was presented in the study from Kashkouli and colleagues; reporting that nearly 90% were bilateral TED. 11 The trend of higher bilateral TED distribution continues in studies conducted elsewhere. 10,[19][20][21] Possible explanations for the higher prevalence of unilateral TED in our study are centred around asymmetry of disease. ...
Background/objectives
Thyroid eye disease (TED), which can lead to severe sequelae, can involve either one eye or both eyes. The importance of knowing the distinction between laterality rests on the risk that either presentation is associated with a more severe form. It is our aim to investigate differences in patient characteristics and presentations between unilateral and bilateral TED.
Methods
Cross-sectional study on clinically diagnosed TED patients from December 2013 to April 2018. Patients’ sociodemographic factors, medical history, presentation, severity, and activity between unilateral TED and bilateral TED were compared.
Results
65 patients were included (unilateral TED: n = 40, 61.5%; bilateral TED: n = 25, 38.5%). Unilateral and bilateral TED were not different with regards to age, gender, family history of thyroid disease, comorbidities, and smoking status. There was nearly six times the likelihood of methimazole intake being associated with bilateral TED (odds ratio [OR] = 5.80, p = 0.02). Both groups were similar in almost all general presentation, orbital inflammation signs, and manifestations of lid retraction. The exception being blurred vision that was more common among bilateral TED patients (OR = 4.80, p = 0.04). There were also no differences between both groups in terms of thyroid hormones (TSH: p = 0.84; freeT4: p = 0.12), severity (p = 0.61), and activity (p = 0.99).
Conclusions
Our study found unilateral TED to be more prevalent while ongoing methimazole treatment and blurred vision are associated with bilateral TED. Our findings add to the growing evidence suggesting that the laterality of TED is not a factor in differentiating levels of activity or severity.
... Thyroid eye disease (TED) is an autoimmune inflammatory orbital disease potential to cause severe functional, aesthetic and psychosocial effects. 1 TED or thyroid associated orbitopathy(TAO) or Graves disease is the most common cause of unilateral and bilateral proptosis in young adults. 2 Pathogenesis include glycosaminoglycan deposition, fibrosis affecting extraocular muscles and adipogenesis in orbit. ...
Thyroid associated orbitopathy (TAO) or graves disease is an autoimmune disorder associated with hyperthyroidism though few cases of hypothyroidism and euthyroidism are also found. Most common presentation is eyelid retraction followed by exophthalmos. Although TAO is more common in women, the proportion in men increases as severity increases. We report a case of young adult woman who presented with proptosis, severe ptosis in right eye and motility restriction in both eye with moderately painful swelling of right eyelid. CEMRI orbit revealed swelling of bilateral recti muscles with sparing of tendons which is characteristic of TAO. Thyroid profile showed hyperthyroid state, Clinical features were suggestive of orbital apex syndrome and diagnosis of TAO was based on orbital muscle changes in MRI. A course of methylprednisolone was given with tapering dose which improved proptosis, ptosis and extraocular movement on follow up.
... Finally, after discarding 25 articles for different reasons (all the patients had hyperthyroidism, did not present ophthalmopathy, or it was not possible to determine the prevalence) 14 articles met all the inclusion criteria, but two articles had the same sample because they were made in the same population. To avoid overrepresentation of this crosssectional study, we included only the data of one of them [22,23] (Fig. 1) (Additional file 3). ...
Background: Thyroid eye disease is an autoimmune disorder of the orbital retrobulbar tissue commonly associated with dysthyroid status. The most frequent condition is hyperthyroidism, although it is also present in hypothyroid and euthyroid patients. The prevalence of thyroid conditions in patients with thyroid eye disease had been previously evaluated; however, there is no consensus on a global prevalence. The study aims to estimate the prevalence of hyperthyroidism, hypothyroidism, and euthyroidism in patients with TED, through a systematic review of literature.
... The diagnosis can be particularly difficult in case with unilateral presence of the clinical signs. Bilateral involvement of TAO can be asymmetric, but unilateral TAO has been reported in only 9% -15% of cases [4]. Asymmetry in the clinical ocular signs was found more commonly in hypothyroid or euthyroid TAO and was rare in hyperthyroid [4] [5]. ...
... Bilateral involvement of TAO can be asymmetric, but unilateral TAO has been reported in only 9% -15% of cases [4]. Asymmetry in the clinical ocular signs was found more commonly in hypothyroid or euthyroid TAO and was rare in hyperthyroid [4] [5]. Periorbital oedema with hypothyroidism is uncommon and it initially mimics other diseases [6]. ...
AbstractThyroid associated ophthalmopathy is an autoimmune disorder whichinvolves orbital and periorbital tissue. The immune-mediated inflammationof the orbital tissues can involve extraocular muscles, orbital connective tissueor orbital fat and periocular soft tissues. Bilateral involvement of thyroidassociated orbitopathy is usually asymmetric, but unilateral thyroid associatedorbitopathy has been less reported. Periorbital oedema as the only sign withhypothyroidism is uncommon and if present, it is more frequent bilaterallypresent and no cases are evidenced as unilateral. Pitting oedema in hypothy-roidism is rare and can be due to increased capillary permeability, decreasedadrenergic tone and increase in serotonin metabolism. Unilateral periorbitaland eyelid oedema can associate with various clinical entities, multidiscipli-nary team is necessary to exclude the concomitant disease, so the patient canimmediately be treated with proper therapy. We represent the case of un-usually unilateral recurrent periorbital oedema in the period of time for 3years with stabilized primary hypothyroidism and multinodular goitre.KeywordsThyroid Associated Ophthalmopathy, Hypothyroidism, Periorbital Oedema
... A large study of 653 normal Caucasians subjects aged 21-80 years found asymmetry to be rare (2%), minor (difference in exophthalmos readings <2mm), and unrelated to gender or age. Another study however showed a linear negative correlation between proptosis and age between the ages of 31 and 80 (19), which was also confirmed independently (20). In the latter study, recruiting a large sample (n = 1,063) of normal Iranian subjects including children, a significantly greater proptosis in the right eye compared with the left via exophthalmometry was shown, though the difference was never greater than 2 mm (21). ...
... Radiological criteria for asymmetry, such a right-to-left ratio of more than 1.4 in extraocular muscle diameter, as obtained by CT measurements based on normative data, have also been proposed (24). Unilateral GO is likewise variably defined as one or more features in one eye without any such manifestations in the other eye (20), proptosis >2 mm in one eye with normal examination of the other eye (25), or proptosis difference between eyes >4 mm, and/or if clinical signs and symptoms of GO found unilaterally (26). In our recently published study, asymmetry was defined as bilateral disease with one or more of the following features: difference between the two eyes in exophthalmos by ≥2 mm; difference in palpebral aperture by ≥2 mm; difference in eyelid swelling by ≥1 grades; difference in eyelid erythema by ≥1 grades; difference in conjunctival redness by ≥1 grades; presence of dysthyroid optic neuropathy in one eye only. ...
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.
