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Clinical Endocrinology Oct 2020Thyroid autoimmunity is the most frequent condition involved in polyautoimmunity (PolyA). However, the frequency of latent and overt PolyA in patients with autoimmune... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Thyroid autoimmunity is the most frequent condition involved in polyautoimmunity (PolyA). However, the frequency of latent and overt PolyA in patients with autoimmune thyroid disease (AITD) as the index condition is unknown. Therefore, the purpose of this study was to determine the prevalence of these types of PolyA in patients with AITD as the index condition.
METHODS
This study adhered to the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Searches through MEDLINE, Embase and LILACS were done to find articles in Spanish and English. Relevant vocabulary terms and key terms related to AITD and other autoimmune diseases were used. Two investigators independently screened the eligible studies, extracted data and assessed the quality and risk of bias. Fixed and random effect models were used accordingly. Cluster analysis was used to determine similarities among diseases in the articles included (based on Jaccard index).
RESULTS
A total of 56 articles fulfilled the inclusion criteria. Of these, 25 were case-controls, 17 were cohorts, and 14 were cross-sectional studies. These studies included a total of 47 509 patients. Female was the predominant gender and included 38 950 patients (81.23%, 95% CI: 80.85-81.60). Graves' disease (GD) was the most common type of thyroid autoimmunity (69.16%, 95% CI: 68.23-70.07). Globally, overt PolyA was found in 13.46% of the patients with AITD. This type of PolyA was represented mainly by type 1 diabetes and autoimmune gastritis. Latent PolyA was presented in 17.45% of the patients, and anti-proinsulin, anti-parietal cells and dsDNA antibodies were the most common. HT had the highest frequency of overt PolyA in Europe (15.60%, 95% CI: 14.72-16.53), whereas latent PolyA was most common in patients with GD in Asia (21.03%, 95% CI: 17.76-24.71). Overt and latent PolyA were associated with gastrointestinal and endocrinological ADs in most of cases and clustered with rheumatological, dermatological and neurological ADs.
CONCLUSIONS
Latent and overt PolyA are common in patients with AITD. These results provide insightful information for early diagnosis and management of concurrent ADs in patients with AITD. Aggregation of ADs in different clusters may help to define different phenotypes associated with thyroid autoimmunity that are critically relevant in clinical settings.
Topics: Autoimmune Diseases; Autoimmunity; Cross-Sectional Studies; Female; Graves Disease; Hashimoto Disease; Humans; Prevalence
PubMed: 32738825
DOI: 10.1111/cen.14304 -
Saudi Journal of Ophthalmology :... 2023The traditional standard of care for Graves' ophthalmopathy (GO) is glucocorticoid therapy, which is associated with many long-term side effects. The aim of this...
PURPOSE
The traditional standard of care for Graves' ophthalmopathy (GO) is glucocorticoid therapy, which is associated with many long-term side effects. The aim of this systematic review and meta-analysis was to compare the traditional therapy to novel monoclonal antibodies (e.g. rituximab [RTX], teprotumumab, and tocilizumab [TCZ]).
METHODS
We searched the Medline, Embase, and Cochrane Central Register of Controlled Trials databases. We included randomized controlled trials (RCTs) that compared different monoclonal antibodies (e.g. RTX, teprotumumab, and TCZ) with glucocorticoids or placebo in patients with GO. We evaluated the clinical activity score (CAS), proptosis, subjective diplopia using the Gorman score, quality of life (QoT), adverse events, change in lid fissure, NOSPECS score, and TSH receptor antibody (TRAb) levels. The odds ratio (OR) was used to represent dichotomous outcomes. The continuous outcomes were represented as standardized mean difference (SMD). Data were pooled using the inverse variance weighting method. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials.
RESULTS
Six ( = 571) RCTs were deemed eligible. The different monoclonal antibodies were significantly more efficacious than glucocorticoid/placebo in terms of reduction in CAS (SMD = -1.44, 95% confidence interval (CI): -1.91--0.97, < 0.00001, = 74%), change in proptosis (SMD = -4.96, 95% CI: -8.02--1.89, = 0.002, = 99%), QoL (SMD = 2.64, 95% CI: 0.50-4.79, = 0.02, = 97%), and Gorman score for diplopia (OR = 3.42, 95% CI: 1.62-7.22, = 0.001, = 8%). However, monoclonal antibodies have shown higher rates of adverse events (OR = 2.91, 95% CI: 1.12-7.56, = 0.03, = 62%). No significant difference was found with respect to lid fissure, NOSPECS, and TRAb levels.
CONCLUSION
This meta-analysis demonstrated that monoclonal antibodies were associated with more favorable clinical outcomes than standard steroid therapy or placebo, especially with regard to CAS, change in proptosis, diplopia, and QoL, with teprotumumab being superior. In addition, only minor safety concerns were identified with monoclonal antibodies though less worrisome than using traditional steroids.
PubMed: 37492211
DOI: 10.4103/sjopt.sjopt_176_22 -
Frontiers in Immunology 2023Graves' disease (GD) and Graves' orbitopathy (GO) development were suspected to be HLA-related in both Asian and Caucasian populations. However, most studies were...
INTRODUCTION
Graves' disease (GD) and Graves' orbitopathy (GO) development were suspected to be HLA-related in both Asian and Caucasian populations. However, most studies were performed with application of serological methods or low resolution genetic typing, which led to inconsistent results even among the same population. The present review is intended to summarize the state-of-art knowledge on the HLA significance in GD and GO in Asians and Caucasians, as well as to find the most significant alleles for each of the populations.
METHODS
PubMed was searched for relevant articles using the following search terms: HLA plus thyroid-associated ophthalmopathy or Graves' disease or Graves' orbitopathy or thyroid eye disease or thyroid-associated orbitopathy.
RESULTS
In Asian population GD was found to be associated mostly with , , , , , and , while , , are potentially protective. can be considered associated with increased risk of GO in Asians, while may play protective role. In Caucasians, , , are associated with GD risk while , may be protective. Significance of HLA in the course of GD and novel aspects of HLA amino acid variants and potential HLA-based treatment modalities were also discussed.
Topics: Humans; Graves Ophthalmopathy; HLA-DQ Antigens; HLA-DRB1 Chains; Haplotypes; Graves Disease; HLA-B Antigens
PubMed: 37841270
DOI: 10.3389/fimmu.2023.1256922 -
International Journal of Environmental... Mar 2023Autoimmune thyroid disease (AITD) is a dysregulation of the immune system that causes an attack on the thyroid gland. Two major clinical manifestations are Hashimoto's... (Review)
Review
Autoimmune thyroid disease (AITD) is a dysregulation of the immune system that causes an attack on the thyroid gland. Two major clinical manifestations are Hashimoto's thyroiditis and Graves' disease. Saliva performs many functions and, importantly, has the potential for easy, non-invasive diagnostics of several systemic disorders. This systematic review was designed to answer the question whether salivary alterations are reliable for the diagnosis of autoimmune thyroid diseases. Following the inclusion and exclusion criteria, fifteen studies were included. Due to their heterogeneity, saliva analysis was divided into two subgroups: quantitative assessment analysing salivation and qualitative assessment concerning potential salivary biomarkers for AITD. In addition to detecting altered levels of thyroid hormones and antibodies, salivary changes were also observed in the concentrations of total protein, cytokines and chemokines, as well as markers of oxidative status. According to the saliva flow rate values, significantly reduced saliva secretion was observed in patients with HT. In conclusion, it is not possible to unequivocally state if salivary biomarkers can potentially be used in autoimmune thyroid disease diagnosis. Therefore, further investigations, including salivation disorders, are necessary to validate these findings.
Topics: Humans; Thyroiditis, Autoimmune; Hashimoto Disease; Graves Disease; Thyroid Hormones; Autoimmune Diseases; Thyroid Diseases
PubMed: 36981758
DOI: 10.3390/ijerph20064849 -
Rhinology Feb 2020The aim of this study was to assess all available data regarding the efficacy of endoscopic transnasal orbital decompression for Graves' ophthalmopathy.
BACKGROUND
The aim of this study was to assess all available data regarding the efficacy of endoscopic transnasal orbital decompression for Graves' ophthalmopathy.
METHODOLOGY
MEDLINE, ScienceDirect and the Cochrane Library databases as well as other sources were searched by two independent reviewers followed by extensive hand-searching for the identification of relevant studies. The primary outcome was the reduction in orbital proptosis. Secondary outcomes were the improvement in visual acuity, post-operative diplopia, and complications RESULTS: Twelve prospective and retrospective case series met the inclusion criteria. All of them demonstrated an improvement in postoperative proptosis that ranged from 2.07 mm to 8.2 mm (weighted mean improvement 5.05 mm). Improvement in visual acuity was reported in all but one study. Studies presented a wide range of results regarding pre-existing and new-onset diplopia. Apart from diplopia, a wide variety of minor and major complications were noted in ten studies, the most serious of which being 3 cases of Cerebrospinal fluid (CSF) leak presented in 2 studies.
CONCLUSIONS
The present systematic review shows that endoscopic transnasal decompression safely addresses symptoms of Graves’ ophthalmopathy. However, high-quality, large-sample, controlled studies need to be performed in the future.
Topics: Decompression, Surgical; Endoscopy; Graves Ophthalmopathy; Humans; Orbit; Treatment Outcome
PubMed: 31884513
DOI: 10.4193/Rhin19.282 -
BMC Endocrine Disorders Jan 2024To evaluate the efficacy and safety of combined glucocorticoids (GCs) and cyclophosphamide (CYC) treatment in Graves' ophthalmopathy (GO). (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the efficacy and safety of combined glucocorticoids (GCs) and cyclophosphamide (CYC) treatment in Graves' ophthalmopathy (GO).
METHODS
We searched PubMed, Embase, Cochrane Library, and four Chinese databases (Chinese National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), WanFang, and SinoMed) for any published randomized controlled trials (RCTs) produced from inception to December 1, 2023. Articles obtained using appropriate keywords were selected independently by two reviewers according to the established inclusion and exclusion criteria.
FINDINGS
We retrieved 1120 records which were eventually reduced to 13 RCTs which were then included in this evaluation. Pooled results indicated that the experimental group (CYC/GCs) showed a higher response rate than control group (GCs or negative control) (RR 1.27; 95% confidence interval 1.19 to 1.37). The subgroup analysis showed that the difference in response rates among treatment protocols (CYC/P, CYC/MPS, CYC/DEX) was not statistically significant (p = 0.23).
IMPLICATIONS
The combination of GCs and CYC could be recommended as a therapeutic option for GO, especially in patients who experience recurrence after a withdrawal GCs, have a poor response to GCs, or cannot obtain monoclonal antibody agents for various reasons.
Topics: Humans; Glucocorticoids; Graves Ophthalmopathy; Cyclophosphamide; China
PubMed: 38273269
DOI: 10.1186/s12902-024-01545-0 -
Frontiers in Oncology 2020Tumor-associated proptosis comprises a frequent phenomenon that negatively impacts quality of life in patients suffering from spheno-orbital meningioma (SOM)....
Tumor-associated proptosis comprises a frequent phenomenon that negatively impacts quality of life in patients suffering from spheno-orbital meningioma (SOM). Therefore, proptosis outcome represents an important measure in meningioma surgery. In the current study, we analyzed our institutional database in order to evaluate the recovery of tumor-associated proptosis in patients with SOM. Between 2009 and 2019, 32 patients with SOM underwent surgical treatment at the authors' institution. The exophthalmos index (EI) was calculated by means of preoperative and postoperative tumor-associated proptosis. Patients with preoperative EI ≥ 1.1 were included in further analysis. Further, we performed a systematic review of the contemporary literature. Favorable proptosis outcome was defined as postoperative decreased EI compared with preoperative EI. Overall, 25 of 32 patients with SOM (78%) suffered from preoperative proptosis in the present series. Preoperative mean EI of 1.37 ± 0.18 decreased after surgical treatment to a postoperative mean EI of 1.15 ± 0.1 during follow-up ( < 0.0001). Systematic review of the literature revealed three studies with individual data on preoperative and postoperative EI measurements leading to a total of 103 patients; 100 of 103 patients (97%) with SOM and preoperative proptosis achieved favorable outcome. The EI provides a comparable standard in evaluation of surgical outcome in patients with tumor-associated proptosis due to SOMs. The large dataset consisting of pooled individual patient data from the systematic review of the literature and the present case series support the assumption that surgical treatment is highly effective in the treatment of tumor-associated proptosis in SOM.
PubMed: 33117710
DOI: 10.3389/fonc.2020.574074 -
World Neurosurgery Dec 2016Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid arteries and the cavernous sinus. CCFs often present with double vision, reduced visual... (Review)
Review
BACKGROUND
Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid arteries and the cavernous sinus. CCFs often present with double vision, reduced visual acuity, and conjunctivitis. Deteriorating ocular symptoms caused by abnormal fistula drainage can cause permanent blindness, and so urgent interventional treatment is necessary. Transvenous embolization of the fistula is the primary treatment option for most patients with symptomatic CCFs. Orbital approaches are considered to be risky compared with the traditional approach via the inferior petrosal sinus and are thus used as a secondary option. These approaches include embolization via the superior ophthalmic vein, inferior ophthalmic vein, and medial ophthalmic vein and direct transorbital puncture. This study aims to assess the merits and risks of orbital approaches in transvenous embolization of CCFs.
METHODS
A systematic review of 30 studies assessing the radiographic and clinical outcomes of this approach was conducted. Outcomes of interest included successful fistula closure, postoperative improvement of ocular symptoms, and complications from the procedure. Weighted averages were calculated for all outcomes.
RESULTS
Transvenous embolization via an orbital approach had a high success rate (89.9%). Improvement in visual acuity and proptosis was found in 93.4% and 88.1% of patients, respectively. There were no major complications. Minor complications found included subconjunctival hemorrhage (n = 4), intraorbital hemorrhage (n = 1), eyelid hematoma (n = 1), and foreign-body granuloma (n = 3).
CONCLUSIONS
All orbital approaches for transvenous embolization of CCFs are effective and safe.
Topics: Carotid-Cavernous Sinus Fistula; Databases, Bibliographic; Embolization, Therapeutic; Humans; Orbit
PubMed: 27586179
DOI: 10.1016/j.wneu.2016.08.087 -
Endocrine Aug 2023Several studies were conducted over the years to find a significant association between non-surgical therapies such as Antithyroid Drug (ATD) Therapy and Radio-iodo... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several studies were conducted over the years to find a significant association between non-surgical therapies such as Antithyroid Drug (ATD) Therapy and Radio-iodo therapy (RIT) with Graves' disease (GD) remission and relapse. However, these investigations did not have a specific focus on the age category of children and adolescents. Hence, this Research is performed to assess the association of non-surgical therapy (ATD and RIT) with Graves' disease (GD) remission and relapse in the children and adolescent population.
DESIGN
A systematic review and meta-analysis of observational studies and clinical trials were carried out.
METHODS
A systematic search of PubMed, EMBASE, and SCOPUS from their inception till April 2022 was performed for studies stating an association between ATD therapy and GD remission and relapse in participants 1-17 years old. The random-effects model was used in the meta-analysis to provide a pooled proportion of both primary outcomes. The quality and each study were assessed using the Newcastle Ottawa Scale (NOS).
RESULT
From 6195 studies searched from the databases, only 16 relevant articles remained after a detailed evaluation. These studies, having a total of 2557 patients aged 5-17 years, were involved in the analysis with a pooled estimate showing a significant association of ATD therapy with GD remission (Estimate: 0.400, 95% Confidence interval: 0.265-0.535; I^2 = 98.16%) and with GD relapse (Estimate: 0.359, 95% Confidence interval: 0.257-0.461; I^2 = 98.26%). Subgroup analyses were conducted to assess the remission rate of different therapies suggesting that antithyroid drugs play a significant role in the remission of the patients. All included studies were classified as moderate quality.
CONCLUSION
Following meta-analysis suggested that the ATD used in the analysis is effective in remitting GD in the children and adolescents population. Nevertheless, long-term RIT therapy and thyroidectomy leads to hypothyroidism. Still, large-sample, and high-quality studies targeting ATDs' use in children and adolescents with long-term surveillance of prognosis are needed.
Topics: Humans; Adolescent; Child; Infant; Child, Preschool; Treatment Outcome; Antithyroid Agents; Graves Disease; Prognosis; Iodine; Recurrence
PubMed: 37115377
DOI: 10.1007/s12020-023-03371-1 -
Journal of Neuro-oncology Jun 2021We aim to systematically review and summarize the demographics, clinical features, management strategies, and clinical outcomes of primary and radiation-induced... (Review)
Review
PURPOSE
We aim to systematically review and summarize the demographics, clinical features, management strategies, and clinical outcomes of primary and radiation-induced skull-base osteosarcoma (SBO).
METHODS
PubMed, Scopus, and Cochrane databases were used to identify relevant articles. Papers including SBO cases and sufficient clinical outcome data were included. A comprehensive clinical characteristic review and survival analysis were also conducted.
RESULTS
Forty-one studies describing 67 patients were included. The median age was 31 years (male = 59.7%). The middle skull-base was most commonly involved (52.7%), followed by anterior (34.5%) and posterior (12.7%) skull-base. Headache (27%), exophthalmos (18%), and diplopia (10%) were common presenting symptoms. Sixty-eight percent of patients had primary SBO, while 25% had radiation-induced SBO. Surgery was the main treatment modality in 89% of cases. Chemotherapy was administered in 65.7% and radiotherapy in 50%. Median progression-free survival (PFS) was 12 months, and the overall 5-year survival was 22%. The five-year survival rates of radiation-induced SBO and primary SBO were 39% and 16%, respectively (P < 0.05).
CONCLUSION
SBO is a malignant disease with poor survival outcomes. Surgical resection is the primary management modality, in conjunction with chemotherapy and radiotherapy. Radiation-induced SBO has a superior survival outcome as compared to its primary counterpart. Complete surgical resection showed a statistically insignificant survival benefit as compared to partial resection.
Topics: Humans; Osteosarcoma; Progression-Free Survival; Skull Base; Skull Base Neoplasms; Treatment Outcome
PubMed: 33999382
DOI: 10.1007/s11060-021-03757-z