Thyroid eye disease

a Southeast Asian experience

Lim, Nigel C S
Sundar, Gangadhara
Amrith, Shantha
Lee, Kok Onn

¹Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
²Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Health System, Singapore
³Division of Endocrinology, Department of Medicine, National University of Singapore

Dr Gangadhara Sundar, Head & Senior Consultant, Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Hospital, 1E, Kent Ridge Road, NUHS Tower Block, Level 7, Singapore 119228, Singapore; [email protected]

Received June 28, 2014

Received in revised form September 2, 2014

Accepted September 30, 2014

British Journal of Ophthalmology 99(4):p 512-518, April 2015. | DOI: 10.1136/bjophthalmol-2014-305649

Aim

To study the demographics, comorbidities, clinical manifestations and treatment methods of thyroid eye disease (TED) in Singapore.

Methods

In this retrospective case series, we analysed the case records of all patients with TED who presented at our multidisciplinary Thyroid Eye Clinic from November 2002 to October 2012.

Results

There were a total of 174 patients—111 female patients (63.8%) and 63 male patients (36.2%). The majority of the patients were ethnically Chinese (80.5%), followed by Malay (10.3%) and Indian (6.3%). The mean age was 40.2 years (SD±15.5, range 0.3–87.0). The commonest sign on ophthalmic examination was eyelid retraction (62.1%), followed by proptosis (61.0%) and lid lag (57.5). Acquired epiblepharon and corneal erosions were noted in 11.5% and 29.3% respectively. Eight patients (4.6%) had dysthyroid optic neuropathy. The mean exophthalmometry reading was 18.8 mm (SD±3.32, range 10.0–28.0). Mild, moderate and severe disease was noted in 71.3%, 20.7% and 8.0% respectively.

Thyroid dysfunction was managed with anti-thyroid medication only (40.2%), β blockers (19.5%), thyroxine replacement (14.4%), radioactive iodine (14.4%) and block-replace regime (9.8%). Clinically significant active orbitopathy was managed with intravenous corticosteroids (12.1%). Surgical procedures consisted of thyroidectomy (10.3%), eyelid surgery (8.6%), orbital decompression (7.5%), epiblepharon correction (2.3%) and strabismus surgery (0.6%).

Conclusions

Corneal erosion secondary to acquired epiblepharon is a common sign in East Asian patients with TED, thus increased awareness among physicians should be encouraged. Mean exophthalmometry values and frequencies of upper eyelid retraction and oedema are lower in East Asian patients compared with Caucasian patients. Among Singapore's multi-ethnic population, Malay patients with TED had the highest exophthalmometry reading.