{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T21:38:29Z","timestamp":1788212309163,"version":"build-2803163510"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011019","name":"Nemzeti Kutat\u00e1si Fejleszt\u00e9si \u00e9s Innov\u00e1ci\u00f3s Hivatal","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011019","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Thyroid eye disease (TED) is an autoimmune disease of the orbit. In moderate to severe active disease, orbital radiotherapy (ORT) is a treatment option. Diabetes is considered a relative contraindication because of potential induction of retinopathy. The purpose of this study was to decide if ORT remains a risk towards retinopathy in the era of linear accelerators with 3D computer aided design. Follow up examinations were performed to detect radiogenic retinopathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Of the 151 patients who received ORT for TED between 2004\u20132020 at the University of Debrecen, 97 patients were available for follow up. In each case, 3D-based LINAC radiotherapy with a total dose of 20 Gy in 2 Gy daily fractions was administered. Eighteen patients had type 2 and one patient had type 1 diabetes. Median duration of diabetes was 16 (IQR:11.75-17.0) years; most recent HbA1c before irradiation was 6.55 (IQR:6.22-6.95) %. Ophthalmological follow up included slit-lamp and fundus examination, visual acuity, exophthalmometry and clinical activity score (CAS) calculation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median time between TED start and ORT was 2 (IQR:1-8) years. At the time of ORT, median TSH was 0.84 (IQR:0-1.41) mU\/L, fT4 18 (IQR:12.15-25.40) pmol\/L and fT3 6.5 (IQR:4.4-11.0) pmol\/L, CAS was 5 (IQR:4-6). No diabetic retinopathy was present before ORT. The median follow-up period after completion of ORT was 60 (IQR:38-100) months. No patient developed retinopathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The risk of radiation-induced retinopathy after orbital irradiation, including well controlled diabetic patients, appears to be negligible. In the absence of pre-existing diabetic retinopathy and with good glycemic control ORT might be safe if linear accelerator with 3D planning is used. However, ophthalmic surveillance is still recommended.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1720650","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T07:43:07Z","timestamp":1765352587000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["No retinopathy after orbital irradiation in patients with thyroid eye disease \u2013 a follow up study"],"prefix":"10.3389","volume":"16","author":[{"given":"Sara","family":"Makhoul","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janos K.","family":"Aranyosi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emese","family":"Csiki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilda","family":"Urbancsek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edit B.","family":"Nagy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annamaria","family":"Erdei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariann","family":"Fodor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arpad","family":"Kovacs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Endre V.","family":"Nagy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernadett","family":"Ujhelyi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.615993","article-title":"Epidemiology, natural history, risk factors, and prevention of graves\u2019 Orbitopathy","volume":"11","author":"Bartalena","year":"2020","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0905750","article-title":"Graves\u2019 Ophthalmopathy","volume":"362","author":"Bahn","year":"2010","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1300196","article-title":"Application of artificial intelligence in the assessment of thyroid eye disease (TED) - 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