Clinical Association of Thyroid Eye Disease with Disease Severity and Thyroid Functional Status-an Experience of a Tertiary Care Hospital, Karachi

Abstract

Objectives: To determine the occurrence and severity of thyroid eye disease regarding thyroid function in patients with autoimmune thyroid disease (AITD).

Study Design: Cross-sectional study.

Place and Duration of Study: Endocrinology Clinics, Jinnah Postgraduate Medical Centre (JPMC) and Medicell Institute of Diabetes Endocrinology & Metabolism (MIDEM) Karachi Pakistan, from Jan to Dec 2020.

Methodology: Patients with AITD or the presence of eye disease were included in the study. Socio-demographic, clinical and laboratory parameters, including thyroid function tests (TFTs), thyroid autoantibodies (TRAb, Anti-TPO, Anti-Tg), presence or absence of eye disease and its severity according to NOSPECS, were documented on a predefined proforma.

Results: A total of 220 patients with a mean age of 35.58±13.52 years and female predominance were included. Hyperthyroid, Hypothyroid and Euthyroid states were found in 125(56.82%), 43(19.5%) and 6(2.7%) of patients, respectively. Eye disease was found in 59(26.81%) patients. The mean NOSPECS score for patients with Grave’s Orbitopathy (GO) for males was 2.56±1.08, and for females, 2.59±1.01. Females had a greater number of TED-related signs and symptoms as compared to men (p=0.01). NOSPECS severity score of TED significantly correlated with fluctuating TFTs and overactive thyroid state (p<0.0001).

Conclusion: Patients with TED commonly presented with proptosis, lid retraction, and restricted movements. The severity of GO was significantly related to older age, female gender, smoking, fluctuating TFTs and hyperthyroidism. Endocrinologists and Ophthalmologists should both work in collaboration for appropriate management.