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  • Oculoplastics/Orbit

    This retrospective study of 3620 cases reports the clinical features and clinical course of thyroid eye disease (TED) in a large number of Chinese patients.

    Study design

    This retrospective, single center, consecutive case series of 3620 Chinese patients with Graves disease collected information on demographic data, clinical manifestations, ophthalmology examinations, and prognosis.


    The female to male ratio was 1.83, and male patients were older than female (peak age 45–50 years and 40–45 years, respectively). Thyroid eye disease most commonly developed after thyroid disease (46.9%), but it may occur simultaneously (39.4%) or before (13.7%). The most frequent symptom in this case series was lid lag, and the most commonly involved extraocular muscle was the inferior rectus (79.9%) followed by the superior rectus (55.6%), medial rectus (49.5%), and lateral rectus (38.2%). Lacrimal gland enlargement was noted in 11.7% of patients. Nearly 90% of patients were clinically inactive, and 3.2% of patients had sight-threatening disease (2.0% with corneal ulceration and 1.2% with optic neuropathy). The active phase lasted less than 12 months in 75.5% of patients, and 2.1% of patients showed complete remission.


    This large study is limited to Chinese patients; differences from previous reports may be due to the difference in ethnicities of the participants. As this is a retrospective study at a tertiary hospital, it may not be representative of TED patients overall.

    Clinical significance

    This case series confirmed a number of findings previously reported in the literature; however, there were a number of significant differences, as well. As previously reported, thyroid-associated ophthalmopathy(TAO) is more common in females and closely related to hyperthyroidism. The ratio of females to males in the Asian populations, however, is less than that noted in White populations, which is closer to 6:1. This series found that euthyroid TED often has an asymmetric clinical phenotype and is less severe. Eyelid lag was the most common finding in this study as opposed to eyelid retraction in others. In addition, the superior rectus muscle was the second most commonly enlarged extraocular muscle. Clinical Activity Score and NOSPECS classifications alone did not detect all active disease, and MRI was often helpful in detecting active disease. A small minority of patients showed complete remission.