Thyroid Diseases: Eckstein A

Bartalena L, Baldeschi L, Dickinson AJ, Eckstein A, Kendall-Taylor P, Marcocci C, Mourits MP, Perros P, Boboridis K, Boschi A, Currò N, Daumerie C, Kahaly GJ, Krassas G, Lane CM, Lazarus JH, Marinò M, Nardi M, Neoh C, Orgiazzi J, Pearce S, Pinchera A, Pitz S, Salvi M, Sivelli P, Stahl M, von Arx G, Wiersinga WM. · Department of Clinical Medicine, University of Insubria, Varese, Italy. · Thyroid. · Pubmed #18341379 No free full text.

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Eckstein A, Esser J. · Universitäts Augenklinik Essen. · Ophthalmologe. · Pubmed #14986660 No free full text.

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Esser J, Eckstein A. · University Hospital, Department of Ophthalmology, Essen, Germany. · Exp Clin Endocrinol Diabetes. · Pubmed #10614926 No free full text.

Abstract: The aim of ocular muscle surgery in Graves' disease is to determine how an optimal normalization of ocular motility disorders - diplopia, compensatory head posture, eyelid dispositions - can be achieved. The results of ocular muscle surgery of fibrotic ocular muscles allow the following conclusions to be drawn. Correcting the motility disorder can be precisely dosed by recessing only one fibrotic ocular muscle with a strabismic angle of up to 15 degrees. This leads to reproducible and dependable results, with a dose-effect coefficient independent of the initial strabismus angle. Indications as to the amount of surgery and which side should be varied according to horizontal an vertical deviations, and are also dependent on the compensatory head posture. Improvement of the binocular visual field is possible in nearly all cases. Over corrections occur more often when the muscle is not directly fixed at the sclera but adjusted on the following day. The time factor is important both before and after the operation. Before the operation, the motility status should have been stable for at least six months. Postoperatively, within the first few days, an insufficient correction should be expected, however this should not lead to premature revision of the amount of surgery. The surgery of the vertical rectus muscles influences the eyelid position. The upper lid retraction is improved with surgery on the vertical extraocular muscle and depends on prior upper lid motility. In contrast, an increase in lower lid retraction is not dependent on an inferior rectus recession. The results permit a precise series of steps to be drawn up in Graves' disease regarding surgical indications, proportionally correcting each side, and the dosage of ocular muscle operations.

Hermsen D, Broecker-Preuss M, Casati M, Mas JC, Eckstein A, Gassner D, van Helden J, Inomata K, Jarausch J, Kratzsch J, Mann K, Miyazaki N, Navarro Moreno MA, Murakami T, Roth HJ, Noh JY, Scherbaum WA, Schott M. · Central Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Duesseldorf, Germany. · Clin Chim Acta. · Pubmed #19091299 No free full text.

Abstract: BACKGROUND: Graves' disease (GD) is mediated by autoantibodies which bind to the TSH receptor (TRAb). The aim of the present study was to evaluate the technical performance of the first fully automated immunoassay for TRAb detection. METHODS: The Elecsys Anti-TSHR immunoassay utilizes a porcine TSH receptor (TSHR) and the human thyroid stimulating monoclonal TSHR autoantibody M22. RESULTS: Intraassay and total imprecision CV were determined between 1.4%-14.9%, and 2.4%-28.8%, respectively. Using the 20% CV criteria the functional sensitivity was found at 0.73 IU/L. The median CV at the cut-off (1.75 IU/L) was found to be 11%. Comparison studies with five TRAb immunoassays yielded slopes and intercepts between 1.02-1.48, and -0.74-0.56, respectively. Correlation coefficients were determined between 0.895 and 0.978. ROC plot analysis of patients with GD, patients with other thyroid disorders and healthy controls revealed an AUC of 0.99 resulting in a sensitivity of 97% and a specificity of 99% at a TRAb level of 1.75 IU/L. CONCLUSION: The evaluation of the TRAb immunoassay generated homogeneous performance data and demonstrated a high degree of comparability to established TRAb assays. The automated TRAb assay represents a major improvement of thyroid testing in clinical practice.

Bartalena L, Baldeschi L, Dickinson A, Eckstein A, Kendall-Taylor P, Marcocci C, Mourits M, Perros P, Boboridis K, Boschi A, Currò N, Daumerie C, Kahaly GJ, Krassas GE, Lane CM, Lazarus JH, Marinò M, Nardi M, Neoh C, Orgiazzi J, Pearce S, Pinchera A, Pitz S, Salvi M, Sivelli P, Stahl M, von Arx G, Wiersinga WM, Anonymous00022. · Department of Clinical Medicine, University of Insubria, 21100 Varese, Italy. · Eur J Endocrinol. · Pubmed #18299459 links to  free full text

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Schott M, Eckstein A, Willenberg HS, Nguyen TB, Morgenthaler NG, Scherbaum WA. · Department of Endocrinology, Diabetes and Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany. · Horm Metab Res. · Pubmed #17226115 No free full text.

Abstract: BACKGROUND: Recently, we and others have demonstrated that high levels of auto-antibodies to the human TSH-receptor (TRAb) predict relapse of hyperthyroidism in Graves' disease (GD). Our objective was to extend the outcome of the prediction by combining TRAb with thyroperoxidase antibody (TPO-Ab) measurement. PATIENTS AND METHODS: One hundred and thirty-one GD patients (118 females, 13 males) were analysed, of whom 94 patients (71.8%) had relapse, whereas 37 (28.2%) went into remission. Second generation TRAb and TPO-Ab assays were performed in GD patients with relapse and remission in mean 4.3 months after initial diagnosis. RESULTS: The mean anti-TPO-Ab levels were similar in all patients with relapse and remission. However, there was a steady decline from 4047 U/ml to 530 U/ml in the remission group that correlated positively with TRAb values (>2 to >10 IU/l). The relapse group remained at consistently high levels. The positive predictive value (PPV) for relapse in patients with TRAbs >6 IU/l and anti-TPO-Abs >5000 U/ml was 100, whereas TRAbs >6 IU/l and anti-TPO-Abs >500 U/ml were associated with a PPV of 93.7 up to 96 (p=0.008). These Ab constellations accounted for about one third of all GD patients. For patients with TRAbs between >2 and <6 IU/l the PPV was 66.7-90.0. CONCLUSION: Our follow-up analysis indicates that the prediction of relapse of GD can be improved by a combined measurement of TRAb and TPO-Ab. In patients with moderately increased Abs, determined about 6 months after initial diagnosis, an ablative therapy can be approached without delay.

Eckstein A, Schulz S, Esser J. · Zentrum für Augenheilkunde, Universität Essen. · Klin Monatsbl Augenheilkd. · Pubmed #15459845 No free full text.

Abstract: BACKGROUND: In Graves' ophthalmopathy squint can be corrected in about two-thirds of the patients with a single recession of an inferior or medialis rectus muscle. The dose-effect correlation is linear over a wide range. Combined vertical and convergent misalignments are rare. The aim of this study was to evaluate the dose-effects in combined recessions of medialis and inferior rectus muscles. MATERIAL AND METHODS: The dose-effect of combined recessions (one side medialis and inferior n = 28, both sides medialis and one side inferior n = 9) was evaluated. The control groups were patients with Graves' ophthalmopathy, who had single inferior recession (n = 187), single medialis recession (n = 37) and bilateral medialis recession (n = 44). RESULTS: Small hypotropias (up to 5 degrees ) at the eye with the poorer abduction disappear after single (17 of 21) or bilateral (11 of 19) medialis recessions. This obvious influence of horizontal recession on the vertical angle leads to a higher dose-effect for the inferior recessions in combined surgery, and was stronger for bilateral cases (from 2.0 degrees to 2.7 degrees /mm recession) than for unilateral cases (from 2.0 degrees to 2.2 degrees /mm recession). The dose-effect for medialis recession in combined surgery increased for the unilateral procedures only from 1.7 degrees to 1.8 degrees /mm recession and not for the bilateral medialis recession. CONCLUSIONS: The dose-effect for combined medialis and inferior recessions is enhanced and varies to a much higher degree in comparison to single muscle recessions. Because of the higher variability, patients who need both medialis and inferior recession should be better operated in separate sessions, beginning with the horizontal muscle(s).

Heinz C, Eckstein A, Steuhl KP, Meller D. · Department of Ophthalmology, University of Essen, Hufelandstr. 55, 45122 Essen, Germany. · Cornea. · Pubmed #15220741 No free full text.

Abstract: OBJECTIVE: To report one case of corneal ulceration associated with a severe manifestation of Graves ophthalmopathy that was treated with amniotic membrane (AM) transplantation using the inlay and overlay technique. METHODS: Case report. RESULTS: A 40-year-old woman with Graves ophthalmopathy had a corneal ulcer on the left eye refractory to topical treatment and orbital decompression surgery. Severe Graves ophthalmopathy was characterized by tear film instability, lagophthalmus, and reduced Bell phenomenon. After amniotic membrane transplantation the epithelial and stromal defect healed quickly with improvement of visual acuity and within the dissolution period of the overlay AM. CONCLUSION: Amniotic membrane transplantation is a successful and alternative approach to treat severe corneal surface disorders refractory to medical treatment in patients with Graves ophthalmopathy. Besides having an anti-inflammatory action mechanism, the overlay AM used herein as a temporary patch was possibly functioning as a protective shield to ensure epithelialization of the AM used as a graft in the ulcer bed.

Eckstein A, Quadbeck B, Mueller G, Rettenmeier AW, Hoermann R, Mann K, Steuhl P, Esser J. · Department of Ophthalmology, University of Essen, Germany. · Br J Ophthalmol. · Pubmed #12770979 links to  free full text

Abstract: BACKGROUND: In patients with Graves' disease, smoking considerably increases the incidence and severity of thyroid associated ophthalmopathy (TAO). The authors sought to determine if smoking also influences the course of TAO during treatment, and the efficacy of therapy. METHODS: 41 smokers and 19 non-smokers with moderate untreated TAO were included in this prospective study. All patients were treated with steroids and, 6 weeks after the beginning of drug therapy, with orbital irradiation. Follow up was performed 1.5, 4.5, 7.5, and 12 months after the beginning of the study. Proptosis, clinical activity score (CAS), and motility were evaluated. The extent of smoking was derived from the concentration of the haemoglobin adduct N-2-hydroxyethylvaline (HEV), a parameter of long term smoking. RESULTS: There was no difference in the clinical manifestations of TAO between smokers and non-smokers at the beginning of treatment. However, CAS decreased (p<0.05) and motility improved (p<0.02) significantly faster and to a greater extent in non-smokers than smokers. Inverse correlations between the CAS decrease and the HEV levels observed 4.5 and 7.5 months after the beginning of treatment and between the improvement of motility and the HEV levels after 1.5, 4.5, and 7.5 months indicated a dose dependence. Mean HEV levels did not vary much during the follow up period and were significantly different in smokers (mean 5.4 (SD 2.7) micro g/l) and non-smokers (mean 1.8 (1.3) micro g/l; p<0.01). CONCLUSION: Smoking influences the course of TAO during treatment in a dose dependent manner. The response to treatment is delayed and considerably poorer in smokers.