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Concept: Graves' ophthalmopathy


BACKGROUND: We would like to investigate the if IMRT produced better target coverage and dose sparing to adjacent normal structures as compared with 3DCRT and LOF for patients with Graves' ophthalmopathy treated with retro-orbital irradiation. METHODS: Ten consecutive patients diagnosed with Graves' ophthalmopathy were prospectively recruited into this study. An individual IMRT, 3DCRT and LOF plan was created for each patient. Conformity index (CI), homogeneity index (HI) and other dosimetric parameters of the targets and organs-at-risk (OAR) generated by IMRT were compared with the other two techniques. RESULTS: Mann–Whitney U test demonstrated that CI generated by IMRT was superior to that produced by 3DCRT and LOF (p=0.005 for both respectively). Similarly HI with IMRT was proven better than 3DCRT (p=0.007) and LOF (p=0.005). IMRT gave rise to better dose sparing to some OARs including globes, lenses and optic nerves as compared with 3DCRT but not with LOF. CONCLUSIONS: IMRT, as compared with 3DCRT and LOF, was found to have a better target coverage, conformity and homogeneity and dose sparing to some surrounding structures, despite a slight increase but clinically negligible dose to other structures. Dosimetrically it might be a preferred treatment technique and a longer follow up is warranted to establish its role in routine clinical use.

Concepts: Hospital, Thyroid disease, Hyperthyroidism, Target Corporation, Graves' ophthalmopathy


Graves' disease (GD), including Graves' ophthalmopathy or orbitopathy (GO), is an autoimmune disease with an environmental and genetic component to its etiology. The genetic contribution to the GO clinical phenotype remains unclear. Previous data from our laboratory and others have suggested that GO has no specific genetic component distinct from GD itself, while other reports have occasionally appeared suggesting that polymorphisms in genes such as CTLA4 and IL23R specifically increase the risk for GO. One of the criticisms of all these reports has been the clinical definition of the GO phenotype as distinct from hyperthyroid GD devoid of clinically significant eye involvement. The objective of this study was to take advantage of a phenotypically pure group of GD patients with GO and examine a series of genes associated with GD to determine if any were more definitively associated with GO rather than Graves' thyroid disease itself.

Concepts: Gene, Thyroid disease, Hyperthyroidism, Thyroid, Autoimmune disease, Graves' disease, Thyroidectomy, Graves' ophthalmopathy


Radioiodine therapy is an effective and safe treatment of hyperthyroidism due to Graves' disease, toxic adenoma, toxic multinodular goiter. We compared the outcomes of a traditional calculation method based on an analytical fit of the uptake curve and subsequent dose calculation with the MIRD approach, and an alternative computation approach based on a formulation implemented in a public-access website, searching for the best timing of radioiodine uptake measurements in pre-therapeutic dosimetry. We report about sixty-nine hyperthyroid patients that were treated after performing a pre-therapeutic dosimetry calculated by fitting a six-point uptake curve (3-168h). In order to evaluate the results of the radioiodine treatment, patients were followed up to sixty-four months after treatment (mean 47.4±16.9). Patient dosimetry was then retrospectively recalculated with the two above-mentioned methods. Several time schedules for uptake measurements were considered, with different timings and total number of points. Early time schedules, sampling uptake up to 48h, do not allow to set-up an accurate treatment plan, while schedules including the measurement at one week give significantly better results. The analytical fit procedure applied to the three-point time schedule 3(6)-24-168h gave results significantly more accurate than the website approach exploiting either the same schedule, or the single measurement at 168h. Consequently, the best strategy among the ones considered is to sample the uptake at 3(6)-24-168h, and carry out an analytical fit of the curve, while extra measurements at 48 and 72h lead only marginal improvements in the accuracy of therapeutic activity determination.

Concepts: Measurement, Therapy, Thyroid disease, Hyperthyroidism, Thyroid, Graves' disease, Graves' ophthalmopathy, Toxic multinodular goitre


The relation between therapy options for Graves' disease (GD) and the course of Graves' ophthalmopathy (GO) are still controversial. Our aim was to compare the occurrence of development or worsening of GO in patients who were treated with antithyroid drugs (ATDs) or radioactive iodine (RAI) or thyroidectomy (TX).

Concepts: Thyroid disease, Hyperthyroidism, Thyroid, Graves' disease, Thyroidectomy, Goitre, Graves' ophthalmopathy, Antithyroid drugs


The treatment of prominent eyes is still a challenging task. As well as the surgery, proper preoperative diagnosis differentiating between patients with and without Graves ophthalmopathy plays an important role. In functionally asymptomatic patients with Graves disease suffering from the aesthetic impairment of prominent eyes, the transpalpebral decompression by intraorbital fat removal technique has been proved to be reliable, effective, safe, and easily performed by a trained and experienced oculoplastic surgeon. This technique provides long-lasting results, leading to improvement not only in visual function but also in personal well-being and in the patient’s social life, with a high benefit-to-risk ratio. The most powerful tool to treat the lower lid deformity and malar bags in patients without Graves disease is the subperiosteal midface lift. It shortens the lid-cheek junction and blends the retaining periorbital ligaments. Furthermore, it adds volume to the lower lid and gives a stable support. By the nature of the procedure, it also turns a negative into a positive vector. In experienced hands, Olivari’s orbital decompression and Hester’s midface lift are ideal options for the treatment of prominent eyes.

Concepts: Hospital, Surgery, Physician, Thyroid disease, Hyperthyroidism, Graves' disease, Goitre, Graves' ophthalmopathy


A 56-year-old man was referred to a dermatologist for assessment of the progression of his thyroid dermopathy. Three years earlier, he had received a diagnosis of Graves' disease with thyroid-associated ophthalmopathy and dermopathy.

Concepts: Thyroid disease, Hyperthyroidism, Thyroid, Graves' disease, Goitre, Graves' ophthalmopathy


TSH receptor antibody (TRAb) is considered the gold standard diagnostic test for the autoimmunity of Graves' disease (GD), which is commonly diagnosed clinically.

Concepts: Medical terms, Diagnosis, Thyroid-stimulating hormone, Thyroid disease, Hyperthyroidism, Graves' disease, Graves' ophthalmopathy


Thyrotropin (TSH) receptor antibody (TRAb) testing is considered accurate for the diagnosis of Graves' disease (GD), and had been identified rarely in thyrotoxic patients without GD. We describe four patients with transient thyrotoxicosis and positive TRAb to highlight this clinical possibility.

Concepts: Immune system, Antibody, Thyroid-stimulating hormone, Thyroid disease, Hyperthyroidism, Graves' disease, Graves' ophthalmopathy, Thyrotropin receptor


Thyrotoxicosis, most often caused by Graves' disease (GD), when treated inadequately may result in premature mortality. There is little consensus as to which of the three treatment options available - antithyroid drugs (ATD), radioactive iodine (RAI) and surgery, is better.

Concepts: Chernobyl disaster, Thyroid disease, Hyperthyroidism, Thyroid, Goitre, Graves' ophthalmopathy, Carbimazole, Antithyroid drugs


Graves' Ophthalmopathy (GO) pathogenesis involves TSH receptor (TSHR)-stimulating auto-antibodies. Whether there are auto-antibodies (stimulating IGFRAbs) that directly stimulate IGF-1 receptors (IGF-1Rs) remains controversial. Herein we attempt to determine whether there are stimulating IGFRAbs in patients with GO.

Concepts: Immune system, Protein, Endocrinology, Thyroid-stimulating hormone, Thyroid disease, Hyperthyroidism, Graves' disease, Graves' ophthalmopathy