Clinical Features Of Thyroid Associated Ophthalmopathy

Objective:To understand the epidemiological characteristics of the patients with thyroid-associated ophthalmopathy(TAO),to explore the risk factors associated with the occurrence of eye disease and summarize the clinical characteristics,and to provide individualized diagnosis and treatment for TAO patients in combination with recent research progress.Methods:From January 2013 to December 2017,376 cases with TAO,we collected the general medical history,symptoms and signs,laboratory examinations,imaging examinations,treatment options and prognosis of the patients.Result:376 patients with TAO,male and female ratio was 1:1.45,and the peak age is 40-55 years old.There were 95 cases with unilateral eye disease and 281 cases with binocular.TAO commonly occurs in patients with Graves’ disease(357 cases),but patients may also present euthyroid(11cases),Hashimotos’ thyroiditis(4 cases)and primary hypothyroidism(4 cases).201 cases(55.07%)were suffered from thyroid dysfunction and ophthalmopathy at the same time,134 cases(36.71%)134 underwent thyroid dysfunction first,and 30 cases(8.22%)first developed thyroid dysfunction.There were 45 cases(11.97%)of smokers,including 2 females cases(0.53%).The frequency of ocular symptoms in TAO patients ranged from high to low was tears,photophobia,diplopia,blurred vision,retrobulbar compression pain,gaze pain and gritty feeling.The frequency of extraocular muscle involvement was inferior rectus,superior rectus,medial rectus and lateral rectus.There were 368 cases who CAS exceeded 3 scores,and the severity was moderate to severe in 367 cases.The CAS and the severity of TAO patients were positively correlated with age(r=0.168,P=0.001).The severity was positively correlated with TRAb(r=0.206,P=0.000).The number of extraocular muscles involved in TAO patients was positively correlated with age(r= 0.417,P=0.000),BMI(r=0.235,P=0.001),TRAb(r=0.260,P =0.000)and thyroid nodules(r = 0.181,P = 0.011).There were 15 children and adolescents,including 11 women.Fifteen patients were all Graves’disease,12 patients with binocular disease and 3 patients with monocular disease.80.32%of the patients were treated with glucocorticoid pulse therapy or glucocorticoid combined with second-line therapy.The improvement rate was 55,31%.Children and adolescents also achieved a higher improvement rate by referring to adult treatment regimens or reducing treatment doses.Conclusion:TAO is more common in women,and the peak age of TAO is 40-55 years old.TAO is most common in Graves’ disease,Hashimoto’s thyroiditis and euthyroid disease.Most ophthalmopathy and thyroid dysfunction occur simultaneously.Binocular involvement is more common.The frequency of extraocular muscle involvement was inferior rectus,superior rectus,medial rectus and lateral rectus.The CAS and severity of TAO patients were correlated with age and TRAb,and the number of extraocular muscle involvement was relevant with age,BMI,TRAb and thyroid nodules.he number of children and adolescents with TAO is significantly less than that of adults,the condition is mild,and the prognosis is well after treatment.