{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:49:48Z","timestamp":1791985788663,"version":"4.4.0"},"reference-count":53,"publisher":"The Endocrine Society","issue":"11","license":[{"start":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T00:00:00Z","timestamp":1722297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Thyroid eye disease (TED), a common extrathyroidal manifestation of Graves disease, poses significant management challenges due to potential disfigurement, visual impairment, and decreased quality of life. Uncertainties remain about the optimal treatment approach, especially regarding TED duration and its impact on outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This meta-analysis evaluates the effects of various treatments on inflammatory markers and severity endpoints in TED, stratified by disease duration, distinguishing between treatments initiated within the first 6 months (initial phase) and those initiated thereafter (subacute\/chronic phase).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA guidelines, a systematic search of multiple electronic databases yielded 26 studies meeting predefined inclusion criteria. Methodological quality was assessed, and data were meticulously extracted and analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the initial phase, treatments like corticosteroids and teprotumumab showed significant improvements in clinical activity score, proptosis, and diplopia. In the subacute\/chronic phase, the efficacy of methylprednisolone and teprotumumab is reduced. A \u201ccritical window\u201d effect was observed, with treatments showing diminished efficacy after 6 months of TED duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This meta-analysis highlights the importance of tailoring treatment strategies based on TED duration, emphasizing early interventions to maximize benefits. The findings guide clinicians in selecting optimal treatments and underscore the need for further research to refine evidence-based approaches, ultimately enhancing patient outcomes and quality of life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgae526","type":"journal-article","created":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T20:43:19Z","timestamp":1722285799000},"page":"2997-3009","source":"Crossref","is-referenced-by-count":18,"title":["Effectiveness of Different Treatment Modalities in Initial and Chronic Phases of Thyroid Eye Disease: A Systematic Review With Meta-analysis"],"prefix":"10.1210","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3286-8619","authenticated-orcid":false,"given":"Jose Mario","family":"Alves Junior","sequence":"first","affiliation":[{"name":"Postgraduate Course Internal Medicine, Campinas State University , Campinas 13083-888, SP ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8597-5207","authenticated-orcid":false,"given":"Wanderley","family":"Bernardo","sequence":"additional","affiliation":[{"name":"Department of Evidence-Based Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 01246-903 , SP ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4173-7258","authenticated-orcid":false,"given":"Danilo","family":"Villagelin","sequence":"additional","affiliation":[{"name":"Postgraduate Course Internal Medicine, Campinas State University , Campinas 13083-888, SP ,","place":["Brazil"]},{"name":"Medical School, Pontifical Catholic University of Campinas , Campinas 13034-685, SP ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2024,7,30]]},"reference":[{"issue":"8","key":"2024101600050386800_dgae526-B1","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1056\/NEJMra0905750","article-title":"Graves\u2019 ophthalmopathy","volume":"362","author":"Bahn","year":"2010","journal-title":"N Engl J Med"},{"issue":"Supplement_1","key":"2024101600050386800_dgae526-B2","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.1210\/clinem\/dgac328","article-title":"Understanding pathogenesis intersects with effective treatment for thyroid eye disease","volume":"107","author":"Smith","year":"2022","journal-title":"J Clin Endocrinol Metab"},{"key":"2024101600050386800_dgae526-B3","first-page":"177","article-title":"Development and course of exophthalmos and ophthalmoplegia in Graves\u2019 disease with special reference to the effect of thyroidectomy","volume":"5","author":"Rundle","year":"1945","journal-title":"Clin Sci"},{"issue":"12","key":"2024101600050386800_dgae526-B4","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1089\/thy.2022.0251","article-title":"Management of thyroid eye disease: a consensus statement by the American Thyroid Association and the European Thyroid Association","volume":"32","author":"Burch","year":"2022","journal-title":"Thyroid"},{"issue":"1","key":"2024101600050386800_dgae526-B5","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1046\/j.1365-2265.1997.2331047.x","article-title":"Clinical activity score as a guide in the management of patients with Graves\u2019 ophthalmopathy","volume":"47","author":"Mourits","year":"1997","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2024101600050386800_dgae526-B6","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2024101600050386800_dgae526-B7","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"Rob 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"2024101600050386800_dgae526-B8","author":"Wells"},{"issue":"12","key":"2024101600050386800_dgae526-B9","doi-asserted-by":"crossref","first-page":"2701","DOI":"10.1177\/09622802211047348","article-title":"Estimating the sample mean and standard deviation from order statistics and sample size in meta-analysis","volume":"30","author":"Cai","year":"2021","journal-title":"Stat Methods Med Res"},{"key":"2024101600050386800_dgae526-B10","author":"O'Sullivan"},{"key":"2024101600050386800_dgae526-B11","doi-asserted-by":"crossref","unstructured":"Alves Junior JM, Bernardo WM, Villagelin D. 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