Oftalmopatisiz Hipertiroidik Hastalarda Optik Cohorens Tomografi Bulguları

Yıl 2023, Cilt: 13 Sayı: 1, 123 - 128, 20.01.2023

Mehmet Tahir Eski , Kuddusi Teberik , Taha Sezer , Atilla Önmez

https://doi.org/10.33631/sabd.1133402

Öz

Amaç: Bu çalışmada, hipertiroidi tanısı olan ve oftalmopati gelişmemiş hastalardaki koroid, retina ve peripapiller sinir lifi tabakasının kalınlığını ötiroid hasta grubuyla karşılaştırmak amaçlanmıştır.
Gereç ve Yöntemler: Hastaların serum tiroid stimülan hormon (TSH), serbest T3 (fT3), serbest T4 (fT4) değerleri incelendi. Hipertiroidi semptomları ile başvuran ve tetkiklerinde TSH; 0,5 mu/L’nin altında saptanan olgular çalışmaya dahil edildi. Spektral domain optik koherens tomografi ile retina kalınlığı (RT), retina sinir lifi tabakası (RSLT) kalınlığı ve koroid kalınlığı (CT) hesaplandı.
Bulgular: Çalışmaya 40’ı (%49) hipertiroidi hastası (HT), 42’si (%51) ötiroidik sağlıklı bireyler olmak üzere toplamda 82 kişi dahil edildi. RT ölçümleri açısından T500, T1000, T1500 ve N1500 değerlerinin HT grupta kontrol grubuna göre daha düşük olduğu olduğu ve bunların istatistiksel olarak anlamlı olduğu görüldü (sırasıyla p<0,001; p<0,001; p<0,001; p=0,011). CT ölçümleri açısından Central, N500, N1000 ve N1500, T500, T1000, T1500, HT grupta daha düşük olduğu ve bunların istatistiksel olarak anlamlı olduğu görüldü (sırasıyla p=0,003; p=0,002; p=0,005; p=0,005; p=0,002; p=0,002; p=0,028). RSLT ölçümleri açısından HT grubunda kontrol grubuna göre T, TS, TI segmentlerinde düşük, NI segmentinde yüksek olduğu ve bu farkın istatistiksel olarak anlamlı olduğu görüldü (sırasıyla p=0,008; p=0,001; p=0,002 ve p=0,009).
Sonuç: Hipertiroidi tespit edilen hastalara, sadece oftalmopatisi olanlara değil oftalmopatisi olmayanlara da tanı konulduktan sonra düzenli göz kontrolleri yapılması gerektiği düşünülmüştür.

Anahtar Kelimeler

Hipertiroidi;, retina kalınlığı;, koroid kalınlığı;, retina sinir lifi kalınlığı

Optic Coherence Tomography Findings in Hyperthyroid Patients without Ophthalmopathy

Öz

Aim The aim of this study is to compare the choroidal, retinal, and peripapillary nerve fiber layer thickness of the patients diagnosed with hyperthyroidism but did not develop ophthalmopathy with the euthyroid patients.
Material and Methods: Thyroid stimulating hormone (TSH), freeT3 (fT3) and freeT4 (fT4) tests of the patients were analyzed. Cases who came in with symptoms of hyperthyroidism and had a TSH lower than 0.5 mu/L were included to the study. Retinal thickness (RT), retinal nerve fiber layer (RNFL) thickness, and choroidal thickness (CT) were calculated by means of spectral domain optical coherence tomography.
Results: A total of 82 participants, covering 40 (49%) hyperthyroid patients and 42 (51%) euthyroid healthy individuals, were examined. In terms of RT measurements, T500,T1000,T1500 and N1500 values were found to be lower in the HT group compared to the control group, and they were statistically significant (p<0.001; p<0.001; p<0.001; p=0.011;respectively). In terms of CT measurements, Central, N500,N1000 and N1500,T500,T1000,T1500 values were found to be lower in the HT group and they were statistically significant (p=0.003; p=0.002; p=0.005; p=0.005; p=0.002; p=0.002; p=0.028; respectively). In terms of RNFL measurements, T, TS, TI segments were found to be lower and NI segment was found to be higher in the HT group compared to the control group, and this difference was statistically significant (p=0.008; p=0.001; p=0.002 and p=0.009; respectively).
Conclusion: As a result, it is advised to regularly perform eye controls of patients with hyperthyroidism, not only the ones with ophthalmopathy but also those without ophthalmopathy, after the diagnosis.

Anahtar Kelimeler

Hyperthyroid,, retinal thickness;, choroidal thickness;, retinal nerve fiber thickness

Kaynakça

• Taylor PN, Albrecht D, Scholz A, Gutierrez-Buey G, Lazarus JH, Dayan CM, et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol. 2018; 14(5): 301-16.
• Mansourian AR. Metabolic pathways of tetraidothyronine and triidothyronine production by thyroid gland: a review of articles. Pak J Biol Sci. 2011; 14(1): 1-12.
• Liu ZW, Masterson L, Fish B, Jani P, Chatterjee K. Thyroid surgery for Graves’ disease and Graves’ ophthalmopathy. Cochrane Database Syst Rev. 2015; 25(11): 1-7.
• Schmidt M, Voell M, Rahlff I, Dietlein M, Kobe C, Faust M, et al. Long-term follow-up of antithyroid peroxidase antibodies in patients with chronic autoimmune thyroiditis (Hashimoto’s thyroiditis) treated with levothyroxine. Thyroid. 2008; 18: 755-60.
• Marino M, Ionni I, Lanzolla G, Sframeli A, Latrofa F, Rocchi R, et al. Orbital diseases mimicking graves’ orbitopathy: a long-standing challenge in differential diagnosis. J Endocrinol Invest. 2020; 43: 401-11.
• Levy J, Puterman M, Lifshitz T, Marcus M, Segal A, Monos T. Endoscopic orbital decompression for Graves’ ophthalmopathy. Isr Med Assoc J. 2004; 6(11): 673-6.
• Casini G, Marino M, Rubino M, Licari S, Covello G, Mazzi B, et al. Retinal, choroidal and optic disc analysis in patients with Graves’ disease with or without orbitopathy. Int Ophthalmol. 2020; 40(9): 2129-37.
• Kurt MM, Akpolat C, Evliyaoglu F, Yilmaz M, Ordulu F. Evaluation of retinal neurodegeneration and choroidal thickness in patients with ınactive graves’ ophthalmopathy. Klin Monbl Augenheilkd. 2021; 238(7): 797-802.
• Yıldırım G, Şahlı E, Alp MN. Evaluation of the effect of proptosis on choroidal thickness in graves’ ophthalmopathy. Turk J Ophthalmol. 2020; 50(4): 221-7.
• Fazil K, Ozturk Karabulut G, Alkin Z. Evaluation of choroidal thickness and retinal vessel density in patients with inactive Graves’ orbitopathy. Photodiagnosis Photodyn Ther. 2020; 32: 101898.
• Çalışkan S, Acar M, Gürdal C. Choroidal thickness in patients with graves’ ophthalmopathy. Curr Eye Res. 2017; 42(3): 484-90.
• Spaide RF, Koizumi H, Pozzoni MC, Pozonni MC. Enhanced depth imaging spectral-domain optical coherence tomography. Am J Ophthalmol. 2008; 146(4): 496-500.
• Bruscolini A, La Cava M, Gharbiya M, Sacchetti M, Restivo L, Nardella C, et al. Management of patients with graves’ disease and orbital ınvolvement: Role of spectral domain optical coherence tomography. J Immunol Res. 2018; 2018: 1454616.
• Teberik K, Eski MT, Doğan S, Pehlivan M, Kaya M. Ocular abnormalities in morbid obesity. Arq Bras Oftalmol. 2019; 82(1): 6-11.
• Yu L, Jiao Q, Cheng Y, Zhu Y, Lin Z, Shen X. Evaluation of retinal and choroidal variations in thyroid-associated ophthalmopathy using optical coherence tomography angiography. BMC Ophthalmol. 2020; 20(1): 421.
• Forte R, Bonavolontà P, Vassallo P. Evaluation of retinal nerve fiber layer with optic nerve tracking optical coherence tomography in thyroid-associated orbitopathy. Ophthalmologica. 2010; 224(2): 116-21.
• Eslami F, Borzouei S, Khanlarzadeh E, Seif S. Prevalence of increased intraocular pressure in patients with Graves’ ophthalmopathy and association with ophthalmic signs and symptoms in the north-west of Iran. Clin Ophthalmol. 2019; 13: 1353-9.
• Gumińska M, Kłysik A, Siejka A, Jurowski P. Latanoprost is effective in reducing high intraocular pressure associated with Graves’ ophthalmopathy. Klin Oczna. 2014; 116(2): 89-93.
• Blum Meirovitch S, Leibovitch I, Kesler A, Varssano D, Rosenblatt A, Neudorfer M. Retina and nerve fiber layer thickness in eyes with thyroid-associated ophthalmopathy. Isr Med Assoc J. 2017; 19(5): 277-81.
• Lai FHP, Iao TWU, Ng DSC, Young AL, Leung J, Au A, et al. Choroidal thickness in thyroid-associated orbitopathy. Clin Exp Ophthalmol. 2019; 47(7): 918-24.
• Del Noce C, Vagge A, Nicolò M, Traverso CE. Evaluation of choroidal thickness and choroidal vascular blood flow in patients with thyroid-associated orbitopathy (TAO) using SD-OCT and Angio-OCT. Graefes Arch Clin Exp Ophthalmol. 2020; 258(5): 1103-7.
• Gul A, Basural E, Ozturk HE. Comparison of choroidal thickness in patients with active and stable thyroid eye disease. Arq Bras Oftalmol. 2019; 82(2): 124-8.
• Luo L, Li D, Gao L, Wang W. Retinal nerve fiber layer and ganglion cell complex thickness as a diagnostic tool in early stage dysthyroid optic neuropathy. Eur J Ophthalmol. 2022; 32(5): 3082-91.
• Chu CH, Lee JK, Keng HM, Chuang MJ, Lu CC, Wang MC, et al. Hyperthyroidism is associated with higher plasma endothelin-1 concentrations. Exp Biol Med (Maywood). 2006; 231(6): 1040-3.
• Yener AÜ, Tayfur AÇ. Posterior segment ocular parameters in children with familial mediterranean fever. Ocul Immunol Inflamm. 2019; 1-6.
• Rolle T, Dallorto L, Briamonte C, Penna RR. Retinal nerve fibre layer and macular thickness analysis with Fourier domain optical coherence tomography in subjects with a positive family history for primary open angle glaucoma. Br J Ophthalmol. 2014; 98(9): 1240-4.
• Eski MT, Oktay M. Ocular blood flow and retinal, horoidal, and retinal nerve fiber layer thickness in children with familial Mediterranean fever with at least five attacks. Int Ophthalmol. 2022; 42(10): 3109-16.