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A retrospective study of pediatric thyroid eye disease: the Asian experience
Bryan Sim1, Chiaw Ling Chng1,2, Chia Audrey1,3
1Singapore National Eye Centre, Singapore, Singapore.
Insights
Pediatric thyroid eye disease (TED) presents milder than adult forms, with proptosis and lid retraction common. Acquired epiblepharon caused the most visual issues, requiring surgical correction in some cases.
Area of Science:
- Ophthalmology
- Endocrinology
- Pediatrics
Background:
- Thyroid eye disease (TED) is an autoimmune condition affecting the orbits, often associated with thyroid dysfunction.
- Pediatric TED is less common and may present differently than in adults.
Purpose of the Study:
- To investigate the clinical features, disease progression, and management of pediatric TED.
- To characterize the presentation and outcomes in children treated at a specialized multidisciplinary clinic.
Main Methods:
- A retrospective case series of 19 pediatric patients diagnosed with TED between 2006 and 2015.
- Diagnosis was based on clinical criteria (Bartley criteria), with data including ophthalmic findings, thyroid function, and interventions recorded.
Main Results:
- The median age at diagnosis was 12.5 years; 52.6% had concurrent thyroid disease, mostly hyperthyroidism.
- Common signs included proptosis (84.2%) and lid retraction (63.2%). Acquired epiblepharon was noted in 63.2% of cases.
- No patients had compressive optic neuropathy. Acquired epiblepharon was the most significant morbidity, with some requiring surgical correction.
Conclusions:
- Pediatric TED generally shows milder symptoms compared to adult cases.
- Acquired epiblepharon is a key cause of visual morbidity in children with TED, impacting the corneal surface.
- Understanding pediatric TED's unique aspects is crucial for effective clinical management.
Aim:
To study the clinical presentation, disease characteristics, and management approach for children with thyroid eye disease (TED) over a 10 year period in a multidisciplinary Paediatric Thyroid Eye Disease Clinic at a tertiary care referral center.
Methods:
Retrospective case series of patients with TED at Kandang Kerbau Women's and Children's Hospital (KKWCH) Singapore between August 2006 to June 2015. The diagnosis of TED was clinical based on the Bartley criteria. Ophthalmic examination findings, systemic thyroid function and ophthalmological intervention were recorded.
Results:
Nineteen subjects with pediatric TED were studied. The median age at diagnosis was 12.5 years (range 6-17). The onset of TED was at the same time as their thyroid disease in half of these patients (52.6%) of which all were hyperthyroid except one. The most common signs at TED diagnosis were proptosis (84.2%), lid retraction (63.2%), acquired epiblepharon (63.2%). All patients were inactive and none had evidence of compressive optic neuropathy. TED remained stable in all patients except for one who developed worsening proptosis with exposure keratopathy. No patients were prescribed steroids (oral or intravenous) or had orbital decompression surgery. The most debilitating morbidity was acquired epiblepharon of which out of 12 patients, one had everting sutures and three were offered surgical correction.
Conclusions:
Paediatric TED subjects exhibit milder clinical manifestations compared to adults. Acquired epiblepharon causes most significant visual morbidity by compromising the corneal surface. Being cognizant of the subtleties of pediatric TED will permit the discerning clinician to effectively manage such cases accordingly.
