Two subtypes distinguish ophthalmic Graves’ disease
SAN FRANCISCO — Rather than thinking of ophthalmic Graves’ disease as one entity classified as “mild” or “moderate to severe,” William R. Nunery, MD, FACS, told colleagues at the American Society of Ophthalmic Plastic and Reconstructive Surgery meeting that thyroid eye disease should be considered as two separate subtypes.
The two types share common features but are largely mutually exclusive, he said, with different natural histories, peak age of onset, gender ratio, smoking prevalence, risk for neuropathy and treatment outcomes.
In type 1 disease, eye motility is essentially normal, whereas in type 2 disease, extraocular muscles demonstrate restrictive myopathy.
Statistically significant differences between the two include peak age of onset at 36 years in type 1 and at 52 years in type 2 (P = .0001); female-to-male ratio of 10:1 in type 1 and 1.5:1 in type 2 (P = .0001); smoking prevalence of 65% in type 1 and 89% in type 2 (P = .002); average orbital asymmetry less than 1 mm in type 1 and greater than 2 mm in type 2 (P =.003); and compressive neuropathy incidence of 0% in type 1 and 36% in type 2 (P = .0001).
“In 40 years, I’ve never seen a type 1 patient develop compressive neuropathy,” Nunery said.
Decompression in type 1 disease is effective and sufficient treatment, Nunery said in the presentation. – by Patricia Nale, ELS
Nunery WR. Michael J. Hawes Lecture: Observations after forty years of managing thyroid eye disease – the importance of subtypes. Presented at: American Society of Ophthalmic Plastic and Reconstructive Surgery meeting; Oct. 10-11, 2019; San Francisco.
Disclosure: Nunery reports no relevant financial disclosures.