Age differences in clinical manifestation and prognosis of thyroid eye disease.
OBJECTIVE
To examine the clinical differences in manifestation, course, treatment, and prognosis of thyroid eye disease (TED) in patients younger than 40 years of age at diagnosis compared to older patients.


METHODS
Medical record review of 131 TED patients was performed. The patients were divided into two age groups, Group 1 ≤ 40 years (23 patients) and Group 2 > 40 years (108 patients).


RESULTS
Younger patients had more eyelid retraction and proptosis at initial presentation, whereas older patients were more likely to have diplopia (P = 0.001). Acute inflammatory signs were more common in the Group 2 patients (P = 0.04). Corrected visual acuity was 20/20 and 20/25 in both groups. Optic neuropathy was diagnosed only in Group 2 patients (n = 12; 11 %), and it resolved after steroids or orbital decompression surgery in all cases. The mean follow-up time was 36 months (36 ± 7.7; 59.3 ± 5.8). Systemic steroid use, orbital surgery, and strabismus surgery were more common in Group 2 (P < 0.0001, P < 0.05 respectively).


CONCLUSIONS
TED under the age of 40 years has different clinical features. In our group of younger patients, the clinical presentation was milder than in the older group with a higher rate of lid retraction and proptosis and lower rate of restrictive myopathy and optic neuropathy. Their disease course was less severe and required less aggressive medical treatment and less surgical procedures.
Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel. guybensimon@gmail.com.|The Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel. guybensimon@gmail.com.
Guy J
GJ
Ben Simon
Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.|The Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel.
Gabriel
G
Katz
Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.|The Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel.
Ofira
O
Zloto
Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel.|The Hebrew University Faculty of Medicine, Jerusalem, Israel.
Hana
H
Leiba
Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel.|The Hebrew University Faculty of Medicine, Jerusalem, Israel.
Beatrix
B
Hadas
Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.|The Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel.
Ruth
R
Huna-Baron
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004172:Diplopia / Q000175:diagnosis*; D015352:Dry Eye Syndromes / Q000175:diagnosis*; D005094:Exophthalmos / Q000175:diagnosis*; D005141:Eyelid Diseases / Q000175:diagnosis*; D005260:Female; D049970:Graves Ophthalmopathy / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014786:Vision Disorders / Q000175:diagnosis*; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology
Eyelid retraction; Optic neuropathy; Orbit; Restrictive myopathy; Thyroid eye disease