Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Tiroid Fonksiyon Bozukluğunda Uygulanan Antitiroid Tedavinin Oküler Yüzey Üzerine Etkisi
The Effect of Antithyroid Treatment on Ocular Surface in Thyroid Dysfunction Patients
İrem AKÖZ ÖZTÜRKa, Dicle HAZIROLANb, Emine DOĞANc, Dilek DELLALd, Uğur Emrah ALTIPARMAKe, Hüseyin ÜSTÜNf, Nurten ÜNLÜb
aGöz Hastalıkları Kliniği, Eskişehir Devlet Hastanesi, Eskişehir, TÜRKİYE
bGöz Hastalıkları Kliniği,
fPatoloji Kliniği, Ankara Eğitim ve Araştırma Hastanesi, Ankara, TÜRKİYE
cGöz Hastalıkları Kliniği, Sakarya Eğitim ve Araştırma Hastanesi, Sakarya, TÜRKİYE dEndokrinoloji ve Metabolizma Hastalıkları Kliniği, Ankara Atatürk Eğitim ve Araştırma Hastanesi, eGöz Hastalıkları Kliniği, Acıbadem Ankara Hastanesi, Ankara, TÜRKİYE
Turkiye Klinikleri J Ophthalmol. 2019;28(2):80-5
doi: 10.5336/ophthal.2018-61563
Article Language: TR
Full Text
ÖZET
 Amaç: Tiroid fonksiyon bozukluğu nedeni ile uygulanan antitiroid tedavinin oküler yüzey ve kuru göz üzerine etkisini değerlendirmektir. Gereç ve Yöntemler: Tiroid fonksiyon bozukluğu mevcut olup, oftalmopatisi olmayan 5 hastanın 50 gözü çalışmaya dâhil edildi. Hastaların 12?si yeni tanı almış ve henüz sistemik medikal tedaviye başlanmamış (Grup 1), 13?ü ise daha önce (en az 4 ay) tanı almış ve tedavi başlanmış hastalardı (Grup 2). Tüm hastalara tam oftalmolojik muayene, gözyaşı kırılma zamanı (GKZ), anestezisiz Schirmer testi ve impresyon sitolojisi uygulandı. Bulgular: Grup 1?de yer alan sekizi kadın, dördü erkek 12 olgunun yaş ortalaması 38,2±5,4 yıl iken; Grup 2?de yer alan yedisi kadın, altısı erkek 13 hastanın yaş ortalaması 44,8±10,0 yıl idi. Grup 1?de ortalama Schirmer değeri 11,25±10,73 mm iken, Grup 2?de 10,80±6,42 mm idi. GKZ Grup 1?de ortalama 9,37±5,02 sn, Grup 2?de ise 8,73±4,06 sn olarak saptandı. Nelson kriterlerine göre yapılan impresyon skorlamasında, Grup 1?de 17 (%70,8) gözde, Grup 2?de 17 (%65,3) gözde Evre 1 ve 2 skuamöz metaplazi bulundu. Her iki grup arasında GKZ, Schirmer testi ve impresyon skorlaması yönünden istatistiksel olarak anlamlı bir fark yoktu. Sonuç: Çalışmamızın sonucunda, tiroid fonksiyon bozukluğu olup; antitiroid tedavi alan ve almayan hasta gruplarının her ikisinde de oküler yüzey bozukluğu saptanmıştır. Bu nedenle, tiroid fonksiyon bozukluğu saptanan hastalara antitiroid tedaviden bağımsız olarak kuru göz tedavisinin başlanması faydalı olabilmektedir.

Anahtar Kelimeler: Tiroid; impresyon sitolojisi; kuru göz; oküler yüzey; antitiroid tedavi
ABSTRACT
 Objective: To eveluate the effect of antithyroid treatment on ocular surface and dry eye in thyroid dysfunction patients. Material and Methods: Fifty eyes of twenty five patients with thyroid dysfunction without ophthalmopathy were included in this study. Twelve of the patients were newly diagnosed and previously untreated (Group 1). Thirteen of the patients (Group 2) were treated with antithyroid treatment at least 4 months. Ophtalmologic examination, Schirmer tear test without anesthesia, tear break-up time and conjunctival impression cytology were perfomed in all patients. Results: Mean age of 12 (8 female, 4 male) patients was 38.2±5.4 years in Group 1 and 13 (7 female, 6 male) patients was 44.8±10.0 years in Group 2. The mean Schirmer tear test score was 11.25±10.73 mm and 10.80±6.42 mm in Group 1 and Group 2 respectively. The mean tear brake up time was 9.37±5.02 sec in Group 1 and 8.73±4.06 sec in Group 2. Impression cytology which is made according to Nelson Criteria showed Grade 1 and 2 squamous metaplasia 17 (70.8%) patients in Group 1 and 17 (65.3%) patients in Group 2. There were no statistically differences in the Schirmer tear test score, tear brake up time and impression cytology between the groups. Conclusions: In our study ocular surface inflammation was detected in both patients group with and without antithyroid treatment. Therefore, regardless of antithyroid treatment, dry eye treatment may be useful in all patients with thyroid disfunctions.

Keywords: Thyroid; impression cytology; dry eye; ocular surface; antithyroid treatment
REFERENCES:
  1. Garrity JA, Bahn RS. Pathogenesis of graves ophthalmopathy: implications for prediction, prevention, and treatment. Am J Ophthalmol. 2006;142(1):147-53. [Crossref][PubMed][PMC]
  2. Stiebel-Kalish H, Robenshtok E, Gaton DD. Pathophysiology of Graves? ophthalmopathy. Pediatr Endocrinol Rev. 2010;7 Suppl 2:17881.
  3. Hiromatsu Y, Eguchi H, Tani J, Kasaoka M, Teshima Y. Graves? ophthalmopathy: epidemiology and natural history. Intern Med. 2014;53(5):353-60. [Crossref][PubMed]
  4. Çelik T, Köşker M. [Update on diagnosis and treatment of thyroid ophthalmıpathy: review]. Turkiye Klinikleri J Ophthalmol. 2014;23(2): 111-20.
  5. Coll J, Anglada J, Tomas S, Reth P, Goday A, Millan M, et al. High prevalence of subclinical Sjögren?s syndrome features in patients with autoimmune thyroid disease. J Rheumatol. 1997;24(9):1719-24.
  6. Gupta A, Sadeghi PB, Akpek EK. Occult thyroid eye disease in patients presenting with dry eye symptoms. Am J Ophthalmol. 2009;147(5):919-23. [Crossref][PubMed]
  7. Brasil MV, Brasil OF, Vieira RP, Vaisman M, Amaral Filho OM. [Tear film analysis and its relation with palpebral fissure height and exophthalmos in Graves? ophthalmopathy]. Arq Bras Oftalmol. 2005;68(5):615-8. [Crossref][PubMed]
  8. Gilbard JP, Farris RL. Ocular surface drying and tear film osmolarity in thyroid eye disease. Acta Ophthalmol (Copenh). 1983;61(1):108-16. [Crossref]
  9. Villani E, Viola F, Sala R, Salvi M, Mapelli C, Currò N, et al. Corneal involvement in Graves? orbitopathy: an in vivo confocal study. Invest Ophthalmol Vis Sci. 2010;51(9):4574-8. [Crossref][PubMed]
  10. Xu N, Huang D, Yang H, Lai Z, Luo Q. Ocular surface characteristics and impression cytology in patients with active versus inactive thyroid eye disease. Eye Sci. 2012;27(2):64-8.
  11. Hegedüs L, Bonnema SJ, Smith TJ, Brix TH. Treating the thyroid in the presence of Graves? ophthalmopathy. Best Pract Res Clin Endocrinol Metab. 2012;26(3):313-24. [Crossref] [PubMed]
  12. Alagöl F. [Treatment of thyrotoxicosis in Graves disease with ophthalmopathy]. Turkiye Klinikleri J Endocrin-Special Topics. 2008; 1(3):62-5.
  13. Azzam I, Tordjman K. Clinical update: treatment of hyperthyroidism in Graves? ophthalmopathy. Pediatr Endocrinol Rev. 2010;7 Suppl 2:193-7.
  14. Pflugfelder SC, Solomon A, Stern ME. The diagnosis and management of dry eye: a twenty-five-year review. Cornea. 2000;19(5): 644-9. [Crossref][PubMed]
  15. Nelson JD, Havener VR, Cameron JD. Cellulose acetate impressions of the ocular surface. Dry eye states. Arch Ophthalmol. 1983; 101(12):1869-72. [Crossref][PubMed]
  16. Toygar O, Yaycıoğlu RA, Sızmaz S. [Tear film analysis in Graves disease]. T Oft Gaz. 2007;37(3):211-5.
  17. Coulter I, Frewin S, Krassas GE, Perros P. Psychological implications of Graves? orbitopathy. Eur J Endocrinol. 2007;157(2):127-31. [Crossref] [PubMed]
  18. Rocha EM, Mantelli F, Nominato LF, Bonini S. Hormones and dry eye syndrome: an update on what we do and don?t know. Curr Opin Ophthalmol. 2013;24(4):348-55. [Crossref][PubMed]
  19. Khalil HA, de Keizer RJ, Kijlstra A. Analysis of tear proteins in Graves? ophthalmopathy by high performance liquid chromatography. Am J Ophthalmol. 1988;106(2):186-90. [Crossref]
  20. Khalil HA, De Keizer RJ, Bodelier VM, Kijlstra A. Secretory IgA and lysozyme in tears of patients with Graves? ophthalmopathy. Doc Ophthalmol. 1989;72(3-4):329-34. [Crossref][PubMed]
  21. Gürdal C, Saraç O, Genç I, Kırımlıoğlu M, Takmaz T, Can I. Ocular surface and dry eye in Graves? disease. Curr Eye Res. 2011;36(1):8-13. [Crossref] [PubMed]
  22. Özkan SB, Söylev MF, Vahapoğlu H, Can D, Arslan KA, Duman S, et al. [The evaluation of conjunctival morphology]. Turkiye Klinikleri J Ophthalmol. 1996;5(1):23-7.
  23. Bartalena L, Tanda ML, Piantanida E, Lai A, Pinchera A. Relationship between management of hyperthyroidism and course of the ophthalmopathy. J Endocrinol Invest. 2004; 27(3):288-94. [Crossref] [PubMed]
  24. Bartalena L. The dilemma of how to manage Graves? hyperthyroidism in patients with associated orbitopathy. J Clin Endocrinol Metab. 2011;96(3):592-9. [Crossref] [PubMed]

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com