title: Unilateral proptosis in thyroid eye disease with subsequent contralateral involvement: retrospective follow-up study.
abstract: BACKGROUND
  The purpose of this retrospective follow-up study is to evaluate the prevalence of patients with thyroid eye disease presenting with apparent unilateral proptosis and determine the occurrence of exophthalmos in contralateral non-proptotic eye over the time. Associated features with this event were evaluated.
  
  
  METHODS
  A cohort of 655 consecutive patients affected by thyroid eye disease with a minimum follow-up of 10 years was reviewed. Exophthalmos was assessed by using both Hertel exophthalmometer and computed tomography (CT). The influence of age, gender, hormonal status and of different therapies such as corticosteroids, radiotherapy and surgical decompression on this disease progression was evaluated.
  
  
  RESULTS
  A total of 89 patients (13.5%) (95% confidence interval [CI] 15%-10%) had clinical evidence of unilateral exophthalmos at the first visit. Among these, 13 patients (14%) (95% CI 22%-7%) developed subsequent contralateral exophthalmos. The increase of protrusion ranged from 2 to 7 mm (mean of 4.2). The time of onset varied from 6 months to 7 years (mean time: 29 months). Smoking status, young age and surgical decompression are significantly associated with development of contralateral proptosis (p< .05).
  
  
  CONCLUSIONS
  Asymmetric thyroid eye disease with the appearance of unilateral exophthalmos at the initial examination is a fairly frequent event, while subsequent contralateral proptosis occurs less commonly. However, physicians should be aware that young patients, particularly if smokers, undergoing orbital decompression in one eye may need further surgery on contralateral side over time.
authors.affiliation: Departement of Visual Science, University of Naples Federico II, Naples, Italy. strianes@unina.it
authors.forename: Diego
authors.initials: D
authors.lastname: Strianese
authors.forename: Raffaele
authors.initials: R
authors.lastname: Piscopo
authors.forename: Andrea
authors.initials: A
authors.lastname: Elefante
authors.forename: Manuela
authors.initials: M
authors.lastname: Napoli
authors.forename: Chiara
authors.initials: C
authors.lastname: Comune
authors.forename: Immacolata
authors.initials: I
authors.lastname: Baronissi
authors.forename: Raffaele
authors.initials: R
authors.lastname: Liuzzi
authors.forename: Mariantonia
authors.initials: M
authors.lastname: Ferrara
authors.forename: Alessia
authors.initials: A
authors.lastname: D'alessandro
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ruggiero
authors.forename: Pasquale
authors.initials: P
authors.lastname: Napolitano
authors.forename: Piergiacomo
authors.initials: P
authors.lastname: Grassi
authors.forename: Adriana
authors.initials: A
authors.lastname: Iuliano
authors.forename: Carmela
authors.initials: C
authors.lastname: Russo
authors.forename: Arturo
authors.initials: A
authors.lastname: Brunetti
authors.forename: Giulio
authors.initials: G
authors.lastname: Bonavolontà
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D005094:Exophthalmos / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013959:Thyroid Diseases / Q000150:complications*; D055815:Young Adult