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Oculoplastics
Thyroid Eye Disease

Risk of dysthyroid optic neuropathy not associated with age in patients with Graves’ orbitopathy

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Younger patients with Graves’ orbitopathy (GO) present with milder clinical features including a lower rate of restrictive motility disorders and less pronounced inflammatory signs while older patients tend to require more steroids, irradiation, and lid and eye muscle surgery. The risk of dysthyroid optic neuropathy (DON) and the need for secondary eye muscle surgery are not or only slightly associated with age, respectively, according to the results from the study.

The severity of GO, an autoimmune disorder leading to inflammation, adipogenesis, and fibrosis, can vary widely among individuals. This can make in challenging to predict the natural course of the disease accurately, which is key to tailoring each patient’s treatment approach.

The researchers reviewed the medical records of a random sample of 1,000 patients in a GO database Essen (GODE) comprising 4,260 patients at the tertiary referral center and compared the clinical characteristics, course, treatment, and prognosis of patients with GO under 50 years with older patients. Study participants were divided into 2 groups: Group 1 (≤50 years) and Group 2 (>50 years). Only those with a complete data set were included in the further statistical analysis.

The results showed that younger patients (n = 484) presented significantly more often with mild GO (53% vs 33%), while older patients (n = 448) were more likely to experience moderate-to-severe disease (44% vs 64%). Older patients showed more severe strabismus, motility, and clinical activity scores. Proptosis and occurrence of DON were 3% in both groups. Multiple logistic regression demonstrated that the need for a second step of eye muscle surgery was most strongly associated with prior decompression followed by orbital irradiation and age. The model showed good fitness for the area under the curve.

Reference
Oeverhaus M, Sander J, Smetana N, et al. How age affects graves’ orbitopathy-a tertiary center study. J Clin Med. 2024;13(1):290. doi:10.3390/jcm13010290

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