title: The relationship between sex and symmetry in thyroid eye disease.
abstract: OBJECTIVE
  To examine the relationships between sex and symmetry in the context of disease activity, severity, and thyroid status in thyroid eye disease.
  
  
  METHODS
  Retrospective chart review of 31 men and 31 women with untreated thyroid eye disease. Subjective complaints, smoking status, thyroid status, and objective findings pertinent to the clinical activity score (CAS) and "NO SPECS" classification were recorded. Overall disease asymmetry was defined as having simultaneous asymmetry of both more than one symptom and more than one external finding. Asymmetry was compared across sex and thyroid status. CAS and NO SPECS severity were compared across sex, symmetry, and thyroid status.
  
  
  RESULTS
  Asymmetric appearance was reported by 58% of men and 19% of women. Asymmetric proptosis (>2 mm difference) was seen in 45% of men and 23% of women (P=0.036). Overall asymmetry was seen in 55% of men and 19% of women (P=0.017). Thyroid status and sex had a combined effect on symmetry, as 15 of 16 hyperthyroid females (94%) demonstrated symmetric disease. Average NO SPECS severity was 3.5 (standard deviation [SD] 1.4) in men and 3.3 (SD 1.1) in women (P=0.51), and was 3.8 (SD 1.4) in asymmetric patients versus 3.2 (SD 1.3) in symmetric patients (P=0.08). The CAS was higher in asymmetric than symmetric patients (1.84 versus 0.97; P=0.012).
  
  
  CONCLUSIONS
  Men demonstrated more asymmetric disease (proptosis and overall asymmetry) than women, while hyperthyroid females demonstrated more symmetry than euthyroid and hypothyroid males and females. NO SPECS severity score was unaffected by sex, thyroid status, or symmetry. Asymmetric patients demonstrated higher clinical activity scores.
authors.affiliation: Department of Ophthalmology and Visual Science, Yale University, New Haven, CT, USA.
authors.forename: Shaheen C
authors.initials: SC
authors.lastname: Kavoussi
authors.affiliation: Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Giacometti
authors.affiliation: Department of Ophthalmology and Visual Science, Yale University, New Haven, CT, USA.
authors.forename: J Javier
authors.initials: JJ
authors.lastname: Servat
authors.affiliation: Department of Ophthalmology and Visual Science, Yale University, New Haven, CT, USA.
authors.forename: Flora
authors.initials: F
authors.lastname: Levin
keywords: Graves’ ophthalmopathy; NO SPECS; clinical activity score; thyroid status