Thyroid Eye Disease

Asymmetric proptosis evolves during active phase of thyroid eye disease

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Although asymmetric proptosis is common in the early active phase of bilateral thyroid eye disease (TED), its frequency decreased by approximately half when the stable phase is reached, according to a study.

In this retrospective study, 51 patients with bilateral, active TED were followed from initial presentation, during the active phase of TED, to the stable phase, and 24-months after achieving stable disease. Asymmetric proptosis was defined as a >2 mm intra-orbital difference in Hertel measurements.

Patients presented at a mean time of 1.1 ± 2.9 months after the start of symptoms and TED stability was established at 15.7 ± 12.3 months.

Of the study participants, 41% demonstrated asymmetric proptosis at initial presentation. When the stable phase was reached, only 22% of patients had persistent asymmetric proptosis.

During the first 3 months of the active phase, the greatest decline in the rate of asymmetric proptosis was noted.

The authors concluded that “this finding supports the surgical paradigm of stable phase, graded orbital decompression, performed when the ultimate globe positions are achieved to avoid late postoperative asymmetry, resulting from the unanticipated evolution of proptosis when surgery is performed during the active phase of TED.”

Tran AQ, Zhou HW, Nanda T, et al. Evolution of asymmetric proptosis during the active phase of thyroid eye disease. Orbit. 2022;doi: 10.1080/01676830.2022.2088807. Epub ahead of print. PMID: 35801656.