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Dakovska et al., Sofia, Bulgaria, tested the presence of
serum antibodies against different pig eye muscle membrane (PEMM) antigens
in 50 patients with TAO, 16 patients with Graves' disease without TAO,
2 patients with Hashimoto's thyroiditis without TAO, 9 patients with non-autoimmune
thyroid diseases, and 15 normals. They found between 12% to 68% positivity
of PEMM antibodies against the different antigens in patients with TAO
and to a lesser extent in patients with Graves' disease without TAO. In
the other groups no circulating autoantibodies were present. Furthermore,
in 14 patients positive for PEMM antibodies, prednisone treatment resulted
in disappearance of these antibodies in 6 patients.
Gerding et al., Amsterdam, The Netherlands, measured quality of life (using Medical Outcomes Study: MOS-24) in 70 consecutive euthyroid patients with different degrees of severity of TAO. Also disease-specific quality was assessed using a newly developed questionnaire (GO-QOL) containing 16 questions concerning two dimensions i.e. visual functioning and appearance. Also 844 patients with diabetes mellitus were tested. It was found that TAO has an important impact on quality of life, even when compared to patients with diabetes. Daroszewski et al., Wroclaw, Poland, studied 24-hour urine excretion of glycosaminoglycans (GAG). It is known that part of the eyesigns in TAO are caused by increased GAG production in the orbit. Eyesigns were assessed by NO SPECS, ultrasound of extraocular muscles and CT scanning of the orbit. GAG excretion during the active phase of TAO was 2052g/24h which was significantly higher than 603g/24h when patients were in remission. The authors conclude that GAG measurement in the urine is a useful marker of activity of TAO and of effectiveness of treatment. Kahaly et al., Mainz, Germany, performed octreoscanning in 20 consecutive patients with Graves' disease with active untreated TAO at 4 and 24hr after injection of tracer before and 3 months after starting antithyroid therapy combined with prednisone. Thyroid octreotide uptake decreased during methimazole: 253 counts vs 95 counts after 24hr. Thyroid uptake was positively correlated with free T3 and with TSH-receptor antibodies in untreated patients. Fourteen/twenty patients responded to prednisone/irradiation therapy with regard to TAO. In these patients orbital octreotide uptake decreased markedly after completion of therapy: 4hr 25 counts vs 6.2 counts before and after therapy respectively. A high pretreatment uptake correlated with a response to therapy with a predictive value of 90%. The authors conclude that octreoscanning in TAO has a high sensitivity with regard to prognosis of treatment and may be used as an semi-objective tool in the evaluation of Graves' TAO and Graves' hyperthyroidism. |
