Bartalena, L. et al. Consensus statement of the European Group on Graves' Orbitopathy (EUGOGO) on management of GO. Eur. J. Endocrinol. 158, 273-285

Department of Clinical Medicine, University of Insubria, 21100 Varese, Italy.
European Journal of Endocrinology (Impact Factor: 4.07). 04/2008; 158(3):273-85. DOI: 10.1530/EJE-07-0666
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a. All patients with GO should (Fig. 1): Be referred to specialist centers; Be encouraged to quit smoking; Receive prompt treatment in order to restore and maintain euthyroidism. b. Patients with sight-threatening GO should be treated with i.v. GCs as the first-line treatment; if the response is poor after 1-2 weeks, they should be submitted to urgent surgical decompression. c. The treatment of choice for moderate-to-severe GO is i.v. GCs (with or without OR) if the orbitopathy is active; surgery (orbital decompression, squint surgery, and/or eyelid surgery in this order) should be considered if the orbitopathy is inactive. d. In patients with mild GO, local measures and an expectant strategy are sufficient in most cases, but treatment may be justified if QoL is affected significantly.

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    • "GO severity and clinical activity stage were evaluated at the patient presentation in our Clinic by trained investigators according to the protocol of our Medical Center. GO severity was evaluated according to the EuGoGo guidelines [9] [10]. Lid fissure width was evaluated in millimeters by a router and proptosis with a Hertel exophthalmometer . "
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    ABSTRACT: Due to the worldwide increasing prevalence of diabetes (DM), patients with both diabetes and Graves' disease (GD) have become more frequent. Sporadic reports indicate that Graves' orbitopathy (GO), a GD complication that affects orbital soft tissues, can be severe in DM patients. The relationship between these diseases is not well understood. This study aims at evaluating the association of GD and GO with autoimmune and non-autoimmune diabetes (DM) and to assess diabetic features that influence GD and GO prevalence and severity. This retrospective study evaluated GD, GO and DM association in 1211 consecutive GD patients (447 with GO and 77 with DM). A case-control study was carried out to evaluate DM relationship with GO severity by comparing at 1:2 ratio GO patients with or without DM. A strong association was found between GD and T1DM (p = 0.01) but not T2DM. Instead, the presence of GO was strongly associated with T2DM (p = 0.01). Moreover, GO was more frequently severe in GD patients with T2DM (11/30 or 36.6%) than in those without T2DM (1/60 or 1.7%, p = 0.05). T2DM was the strongest risk factor for severe GO (OR = 34.1 vs. 4.4 p < 0.049 in cigarette smokers). DM duration, obesity and vascular complications, but not metabolic control were significant determinants of GO severity. GD is associated with T1DM but not with T2DM, probably because of the common autoimmune background. GO, in contrast, is more frequent and severe in T2DM, significantly associated with obesity, diabetes duration and diabetic vasculopathy but not metabolic control. Copyright © 2015 Elsevier B.V. All rights reserved.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 01/2015; 25(5). DOI:10.1016/j.numecd.2015.01.003 · 3.32 Impact Factor
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    • "Diagnosis of TED was based on the criteria of the European Group on Graves' Orbitopathy Consensus Statement [27] [28]. Thyroid ophthalmopathy activity was defined by using the VISA classification for TED [29]. "
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    ABSTRACT: The purpose of this study is to investigate the effect of thyroid eye disease (TED) on the measurement of corneal biomechanical properties and the relationship between these parameters and disease manifestations. A total of 54 eyes of 27 individuals with TED and 52 eyes of 30 healthy control participants were enrolled. Thyroid ophthalmopathy activity was defined using the VISA (vision, inflammation, strabismus, and appearance/exposure) classification for TED. The intraocular pressure (IOP) measurement with Goldmann applanation tonometer (GAT), axial length (AL), keratometry, and central corneal thickness (CCT) measurements were taken from each patient. Corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF) and noncontact IOP measurements, Goldmann-correlated IOP (IOPg) and corneal-compensated IOP (IOPcc) were measured with the Ocular Response Analyzer (ORA) using the standard technique. Parameters such as best corrected visual acuity, axial length, central corneal thickness, and corneal curvature were not statistically significant between the two groups (p > 0.05). IOP measured with GAT was higher in participants with TED (p < 0.001). The CH of TED patients was significantly lower than that of the control group. There was no significant difference in the corneal resistance factor between groups. However, IOPg and IOPcc were significantly higher in TED patients. CH and VISA grading of TED patients showed a negative correlation (p = 0.007). In conclusion, TED affects the corneal biomechanical properties by decreasing CH. IOP with GAT and IOPg is found to be increased in these patients. As the severity of TED increases, CH decreases in these patients.
    The Kaohsiung journal of medical sciences 06/2014; 30(6):299-304. DOI:10.1016/j.kjms.2014.02.015 · 0.80 Impact Factor
    • "Clinical activity of GO was classified as per clinical activity score (CAS) recommended by EUGOGO1213. A CAS of 0-2 was considered inactive and 3-7 active GO121316. Severity of GO was classified into mild, moderate-severe and sight-threatening based on the EUGOGO classification13. "
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    ABSTRACT: Background & objectives: The prevalence of Graves’ ophthalmopathy (GO) varies widely in different ethnic groups. Indians have been reported to have a lower prevalence of Graves’ ophthalmopathy as compared to Caucasians of European origin, but data are sparse and inconclusive. We studied the prevalence, clinical features and association of GO in Indian patients with Graves’ disease attending a referral centre in north India. Methods: A prospective study was conducted on 235 consecutive newly referred north Indian patients with Graves’ disease presenting to a tertiary care centre in north India. All patients underwent a comprehensive ophthalmological examination as per the European Group on Graves’ Orbitopathy (EUGOGO) recommendations. Results: GO was diagnosed in 65 patients (prevalence 28%; 95% confidence interval 22-33%). The prevalence was similar in males (28%) and females (27%). It was mild in 83 per cent, moderate-severe in 15 per cent and sight-threatening in only 2 per cent of cases. Ophthalmopathy was clinically active in only two (3%) cases. Upper eyelid retraction was the most common manifestation (83%), followed by exophthalmos (75%). Extra-ocular muscle involvement (5%) and optic nerve dysfunction (2%) were uncommon. The risk of GO was 3.9- fold (95% confidence interval 1.1-13.6) higher in smokers compared to non-smokers. However, severity of disease in smokers was similar to non-smokers. On multivariate logistic regression analysis, GO was associated only with high thyrotropin receptor antibody titres and current smoking. Interpretation & conclusions: Among north Indian patients with GD studied at a referral center, the prevalence of GO was similar to Caucasians of European descent, but clinically active and severe ophthalmopathy was uncommon. More studies are needed to confirm these findings.
    The Indian Journal of Medical Research 01/2014; 139(1):99-104. · 1.40 Impact Factor
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