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. 2025 Jul 22;18(1):37.
doi: 10.1186/s13044-025-00249-4.

Predictive demographic and clinical features for the development of dysthyroid optic neuropathy in a multi-ethnic TED population: a retrospective cohort study

Malik Moledina  1   2 , Vickie Lee  3   4 , Ahmed Alnahrawy  1   2 , Ourania Fydanaki  2 , Nicole George  5 , Nour Hubby  5 , Daisy Metcalf  5 , Natalie Man  5 , Gabriella Guevara  2 , Claire Feeney  6   7 , Rashmi Akshikar  2 , Rajni Jain  1   2 , Ahmad Aziz  1   2 , Vassiliki Bravis  6   7 , Karim Meeran  6   7
Affiliations

Predictive demographic and clinical features for the development of dysthyroid optic neuropathy in a multi-ethnic TED population: a retrospective cohort study

Malik Moledina et al. Thyroid Res. .

Abstract

Background: Dysthyroid Optic Neuropathy (DON) is a sight-threatening complication of Thyroid Eye Disease (TED). This study aims to identify the risk and predictive factors for DON in a multi-ethnic TED cohort.

Methods: Retrospective, cohort study of consecutive TED patients attending a multidisciplinary service over an 11-year period. Consecutive patients aged over 18 years old with a minimum of 6 months follow-up post-diagnosis of TED were included. We compared those patients with DON and those without (no-DON) to determine which factors were more prevalent in patients with DON.

Results: There were 26 and 516 consecutive patients with DON and no-DON. The DON prevalence in the cohort was 5.0%. The DON group had a Mean Age at TED Diagnosis (MATD) of 57.8 vs. 46.1 years in the no-DON group. The mean presenting CAS, TRAb and Gorman Diplopia Score (GDS) were significantly higher 3.73 ± 1.80, 2.76 ± 1.05 and 11.31 ± 11.90 vs. 0.54 ± 0.80, 0.48 ± 0.90 and 6.95 ± 9.22 in the DON compared to the no-DON group respectively (p = 0.00, p = 0.00 and p = 0.04). On multivariable regression, we found the following risk factors for developing DON (Odds Ratios): MATD ≥ 53 years (5.2 p = 0.00), presenting CAS ≥ 4 (P = 0.00), presenting GDS ≥ 3 (7.5 p = 0.00), diabetes (5.7 p = 0.00), and baseline TRAb ≥ 5.0 IU/L (2.9 p = 0.04).

Conclusion: Patients with diabetes, increased MATD, and high presenting CAS, GDS, and TRAb are at increased risk of developing DON in our cohort. Clinicians should be especially vigilant of the risk of sight-threatening complications in TED patients with more than one of the above risk factors.

Keywords: Dysthyroid optic neuropathy; Graves orbitopathy; Risk factors; Thyroid eye disease.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the institutional audit department and was conducted by the tenets of the Declaration of Helsinki and all laws in the United Kingdom. Consent for publication: Not applicable. Competing interests: Miss Vickie Lee is the Principal Investigator for the Horizon, Viridian, Lassen and Sling Trials, BOPSS National Lead for Thyroid Eye Disease and has been a consultant for Horizon/Amgen and Viridian Pharmaceuticals. Mr Malik Moledina is: Sub Investigator for the Viridian, Horizon and Sling Trial. Miss Ourania Fydanaki, Miss Gabriella Guevara & Dr Nour Houbby are Sub Investigators for the Horizon Trial. Dr Claire Feeney is a Pfizer employee in an unrelated field since June 2018. This paper was recently presented at ESOPRS Rotterdam 2024, and formed part of the submission that went on to win the ESOPRS Richard Collins Prize 2024.

Figures

Fig. 1
Fig. 1
Strobe diagram depicting excluded participants
Fig. 2
Fig. 2
Univariable and multivariable binary regression analysis of DON risk factors
Fig. 3
Fig. 3
Univariable and multivariable binary regression analysis of DON risk factors represented as odds ratio plot (bottom)
Fig. 4
Fig. 4
Top: Pie chart of presenting signs and symptoms during the diagnosis of DON, Middle: Proportion of patients recovered following treatment of DON. Bottom: Pie Chart identifying multiple criteria used to diagnose DON with an average number of 3.4 per patient
See this image and copyright information in PMC

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