Comparison of Patient Characteristics in Thyroid-Associated Ophthalmopathy with and without Strabismus

Kyung Jun Choi; Seung Hyun Kim; Joo Yeon Lee

doi:10.3341/jkos.2015.56.10.1610

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Choi, Kim, and Lee: Comparison of Patient Characteristics in Thyroid-Associated Ophthalmopathy with and without Strabismus

Original Article

J Korean Ophthalmol Soc 2015;56(10):1610-1616.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.10.1610

Comparison of Patient Characteristics in Thyroid-Associated Ophthalmopathy with and without Strabismus

Kyung Jun Choi, M.D¹, Seung Hyun Kim, M.D, PhD², Joo Yeon Lee, M.D, PhD^1,

¹Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea

²Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Joo Yeon Lee, MD, PhD Department of Ophthalmology, Hallym University Sacred Heart Hospital, #22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea Tel: 82-31-380-3834, Fax: 82-31-380-3833 E-mail: kimleejy@hallym.or.kr

Received 17 April 20151 June 2015 Accepted 23 July 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To determine immunochemical and clinical differences in thyroid-associated ophthalmopathy (TAO) patients with re-strictive strabismus and without strabismus.

Methods

A retrospective chart review of 15 TAO patients with strabismus (25 eyes) and 24 TAO patients without strabismus (39 eyes) who presented to the Ophthalmology Clinic between August 2011 and December 2013 was performed. Visual acuity, in-traocular pressure (IOP), Hertel exophthalmometry, soft tissue score, and enlargement of extraocular muscles on computed to-mography (CT) were obtained and compared in each group. Thyroid related autoantibody (thyroid-stimulating hormone receptor antibody, TRAb; thyroid peroxidase antibody, TPOAb; anti-thyroglobulin antibody, TgAb) titers and positive rates were obtained at the time of diagnosis or before treatment and analyzed.

Results

The gender and smoking proportion were not significantly different between the 2 groups. The mean age of TAO pa-tients with strabismus was 52.53 years and of TAO patients without strabismus 40.33 years ( p = 0.004). The differences in visual acuity and IOP between the 2 groups were not significant. Hertel exophthalmometry showed less proptotis in the TAO with stra-bismus group than the TAO without strabismus group (16.84 mm versus 18.67 mm). The soft tissue score was not significantly different. The extraocular muscle enlargement rate of TAO with strabismus was significantly higher than in TAO without stra-bismus group. In the TAO with strabismus group, TRAb level was higher than in the TAO without strabismus group ( p = 0.021).

Conclusions

The TAO with strabismus group was older and had higher positive rate, level of TRAb, and extraocular muscle en-largement rate on CT than the TAO without strabismus group. Furthermore, proptosis was less definite in the TAO with stra-bismus group.

Keywords: Autoantibody, Extraocular muscle enlargement, Restrictive strabismus, Thyroid associated ophthalmopathy, Thyroid stimulating hormone receptor antibody

References

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Table 1.

Demographics of TAO with strabismus patients and TAO without strabismus patients

	TAO with strabismus	TAO without strabismus	p-value
Study population	15	24
Age (years)	52.20 ± 10.86	40.33 ± 12.47	0.004^*
Gender (male:female)	5:10	11:13	0.440^†
Smoking	4 (26.67%)	10 (41.67%)	0.342^†

Values are presented as mean ± SD unless otherwise indicated. TAO = thyroid-associated ophthalmopathy.

^* Independent t-test;

^† Pearson chi-square test.

Table 2.

Ocular parameters of TAO with strabismus patients and TAO without strabismus patients

	Eyes of TAO with strabismus (n = 26)	Eyes of TAO without strabismus (n = 39)	p-value
Visual acuity (log MAR)	0.02 ± 0.04	0.07 ± 0.20	0.072^†
IOP (mm Hg)	17.54 ± 6.60	16.20 ± 3.17	0.280^†
Hertel ophthalmometry (mm)	16.84 ± 3.23	18.67 ± 2.10	0.008^†
Soft tissue score^*	1.20 ± 0.70	1.03 ± 0.58	0.309^†
Muscle enlargement	15/15 (100%)	7/24 (29.17%)	0.000^‡
Direction of restrictive strabismus
Hypertropia	3
Hypotropia	6
Esotropia	2
Exotropia	1
Combined	3

Values are presented as mean ± SD unless otherwise indicated. TAO = thyroid-associated ophthalmopathy; log MAR = log of the minimum angle of resolution; IOP = intraocular pressure.

^* Soft tissue involvement score of modified NOSPECS score;

^† Independent t-test;

^‡ Pearson chi-square test.

Table 3.

Thyroid-associated autoantibodies and extraocular muscle enlargement

		TAO with strabismus	TAO without strabismus	p-value
Study population		15	24
TSH		1.26 ± 2.14	3.36 ± 13.61	0.559^*
TRAb	Titer	12.71 ± 8.20	6.95 ± 8.09	0.040^*^†
	Positive rate	15/15 (100%)	17/24 (70.83%)	0.021^†
TPOAb	Titer	29.60 ± 47.11	44.57 ± 67.15	0.530^*^†
	Positive rate	2/15 (13.33%)	9/22 (40.91%)	0.103^†
TgAb	Titer	98.00 ± 219.47	110.83 ± 168.75	0.859^*^†
	Positive rate	1/15 (6.67%)	5/21 (23.81%)	0.233^†

Values are presented as mean ± SD unless otherwise indicated. TAO = thyroid-associated ophthalmopathy; TSH = thyroid stimulating hormone; TRAb = thyroid stimulating hormone receptor antibody; TPOAb = thyroid peroxidase antibody; TgAb = anti-thyroglobulin antibody.

^* Independent t-test;

^† Pearson chi-square test.

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