Disclosures: The authors report no relevant financial disclosures.
September 04, 2020
2 min read

Thyroid eye disease present in 40% of people with Graves’ disease

Disclosures: The authors report no relevant financial disclosures.
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Two of five people with Graves’ disease worldwide have thyroid eye disease, with higher rates among Asian populations vs. other ethnicities, according to a meta-analysis published in Clinical Endocrinology.

“Thyroid eye disease is a very common manifestation among patients with Graves’ disease,” Khoo Chin Meng, MBBS, MRCP, FAMS, assistant professor in the department of medicine and head and senior consultant in the division of endocrinology at National University of Singapore Yong Lu Linn School of Medicine, and researchers wrote. “Active screening for thyroid eye disease is recommended, especially among those with lid retraction and proptosis.”

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Researchers searched two electronic databases, Medline and Embase, for articles from inception through April of 2020. The analysis included 57 articles (n = 26,804) from various regions that described the prevalence of thyroid eye disease, its signs and symptoms, and practice and management. Data extracted from the articles included the study’s country of origin, patient characteristics, the proportion of thyroid eye disease, classification guidelines and ophthalmic signs and symptoms.

Based on 33 articles, the pooled prevalence of thyroid eye disease among 22,384 people with Graves’ disease was 40% (95% CI, 0.32-0.48). The prevalence was similar when articles with a high risk for bias were removed (38%; 95% CI, 0.30-0.48) and when studies using only the NOSPECS classification of Graves’ disease were removed (40%; 95% CI, 0.30-0.49).

Researchers broke down the prevalence of thyroid eye disease by continent and ethnicity. The pooled prevalence for thyroid eye disease was 44% in Asia (95% CI, 0.32-0.56; n = 4,658), 38% in Europe (95% CI, 0.31-0.46; n = 8,474) and 27% in North America (095% CI, 0.06-0.56; n = 8,662). Oceania had the highest prevalence of thyroid eye disease at 58% (95% CI, 0.55-0.61; n = 1,042), but only one article in the study focused on the region. Researchers also assessed the prevalence of thyroid eye disease specifically in Southeast Asia (35%; 95% CI, 0.24-0.47; n = 463) and the Middle East (48%; 95% CI, 0.19-0.78; n = 1,250).

People of Asian ethnicities had a higher prevalence of thyroid eye disease (45%; 95% CI, 0.33-0.58; n = 4,423) than white people (37%; 95% CI, 0.28-0.46; n = 17,581). While there was no significant difference reported between the two groups, researchers said another study should focus on why Asians appear to be more susceptible to thyroid eye disease.

“This slight difference in prevalence of thyroid eye disease among Asians could be due to genetic predispositions, biochemical factors or the high prevalence of smokers,” researchers wrote.

Lid retraction (57%; 95% CI, 0.39-0.74; n = 1,101) and proptosis (57%; 95% CI, 0.48-0.65; n = 2,457) were the most common clinical manifestation of thyroid eye disease, followed by diplopia (36%; 95% CI, 0.24-0.48; n = 2,029) and ocular hypertension (13%; 95% CI, 0.06-019; n = 2,651).

Researchers noted 22 studies in the meta-analysis did not follow any guidelines for diagnosing thyroid eye disease. They urged practitioners to create standard reporting for the disease to allow for better understanding of the clinical burden and to provide better resources for patients and providers.