148 research outputs found
Risk Factors Associated with the Severity of Thyroid-Associated Orbitopathy in Korean Patients
Risk Factors Associated with the Severity of Thyroid-Associated Orbitopathy in Korean Patientsope
Outcomes after urgent thyroidectomy following rapid control of thyrotoxicosis in Gravesâ disease are similar to those after elective surgery in well-controlled disease
Background
Surgery for Gravesâ disease (GD) is usually performed after adequate control with medical treatment. Occasionally, rapid pre-operative optimization is required. The primary objective was to compare the outcomes of patients undergoing elective surgery for well-controlled GD with those undergoing rapid pre-operative treatment. We also propose a formal treatment protocol for future use.
Methods
A retrospective cohort study in a tertiary referral centre included 247 patients with well-controlled GD undergoing elective surgery and 19 patients with poorly controlled disease undergoing surgery after rapid optimization. The latter group did not respond well to thionamides (carbimazole and/or propylthiouracil) or had intolerance or side effects to thionamides and were treated with a range of non-thionamide drugs, including Lugolâs iodine, cholestyramine, beta blockers and steroids (with or without thionamides), and closely monitored for 1â2 weeks before surgery. Outcome measures included thyroid storm, hypoparathyroidism and recurrent laryngeal nerve palsy.
Results
In total, 266 patients with male-to-female ratio of 1:6 and median (interquartile range) age of 39 (31â51) were included. Overall, long-term recurrent laryngeal palsy and hypoparathyroidism occurred in 1 (0.38%) and 13 (4.9%) patients, respectively. No patient had thyroid storm. There was no significant difference in hypoparathyroidism (pâ=â1), vocal cord palsy (pâ=â0.803) and post-operative bleeding (pâ=â0.362), between elective surgery and rapid optimization groups.
Conclusion
Rapid pre-operative treatment is effective, safe and is associated with similar outcomes compared to usual treatment. A rapid pre-operative optimization protocol is proposed
Effects of treatment modalities for Gravesâ hyperthyroidism on Gravesâ orbitopathy: a 2015 Italian Society of Endocrinology Consensus Statement
Saccadic eye movement velocity measured with the infrared reflection and search coil eye-tracking systems in patients with thyroid-associated ophthalmopathy.
Background Assessment of changes in saccade velocity may be useful in the early detection of thyroid-associated ophthalmopathy (TAO). Two eye-tracking systems were used to measure the velocity of saccadic eye movements in patients with TAO. Method Fourteen patients with active TAO and 14 healthy controls were enrolled for recordings with two eye-tracking systems: the magnetic scleral search coil (MSC; Skalar Medical) and the infrared reflection systems (IR; Orbit XY-1000). The MSC is generally considered the "gold standard" method for tracking of rapid eye movements. The IR system uses novel computer technology and is based on sampling of reflected infrared light from the surface of the eyes. Main sequence plots constructed from the recorded saccadic peak velocity and amplitude were analyzed for differences between patients and healthy controls. Results There were no significant differences between patients with TAO and healthy controls in the constructed main sequence plots of maximum velocity (VMAX) and the slope constant (C). Conclusions Main sequence analysis of saccadic eye movements was not useful for detecting TAO in this experimental setting with either of the two eye-tracking methods. This is hypothesized to be due to compensation for the early orbital changes in TAO by neural adaptation of the saccades in the brain stem. The contradictory results between this and previous studies cannot be easily explained. We assume that there is a large heterogeneity in the saccadic eye movement performance in both the normal population and the TAO-population. Also, differences in the study design may cause dissimilar outcomes and hence incoherent conclusions. A non-invasive recording system that is able to generate a minimum amount of intra- and inter-individual variability and a study design where normal variability can be reduced to a minimum may be useful for future identification of early eye muscle changes in TAO
Results of transantral orbital decompression in patients with thyroid-associated ophthalmopathy
Relation between Gravesâ orbitopathy and radioiodine therapy for hyperthyroidism: facts and unsolved questions*
Short-term use of Infliximab in a case of recalcitrant idiopathic orbital inflammatory disease
Radioiodine therapy (RAI) for Gravesâ disease (GD) and the effect on ophthalmopathy: a systematic review*
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