Glabellar Rhytids in Thyroid Eye Disease: Severity and Their Impact on Emotional Perception
Mannat Kaur, Noemi D. Rivera, Sugi P. Lazarus, Sara T. WesterABSTRACT
Purpose
To quantify glabellar rhytid severity in patients with Thyroid Eye Disease (TED) compared to age‐and sex‐matched controls and to evaluate its impact on external emotional perception.
Methods
A matched case–control study was performed comparing patients with TED of at least 6 months duration to controls (healthy individuals with no history of TED). Standardized photographs were cropped to the glabellar region. Controls were matched to cases by sex and age within five‐year intervals. Images were independently evaluated by masked assessors. Glabellar rhytid severity was graded using a validated 4‐point glabellar‐line severity scale. Perceived emotion expression was assessed across 7 categories: neutral, anger, disgust, sadness, fear, happiness, and surprise.
Results
A total of 90 patients (45 TED and 45 controls) were analyzed by 9 independent assessors. Patients with TED demonstrated significantly greater glabellar rhytid severity than controls (mean GLS score, 2.55 vs. 2.23 respectively; paired t ‐test, p = 0.013). A generalized linear mixed model accounting for reviewer variability and matched‐pair design demonstrated that TED images had 47% higher odds of receiving negative emotion rating than control images (OR = 1.47, 95% CI = 1.06–2.02; p = 0.019). Compared with controls, TED images were frequently perceived as expressing anger and disgust and less frequently perceived as neutral. Glabellar rhytid severity correlated positively with proptosis severity.
Conclusions
Patients with TED exhibit significantly more severe glabellar rhytids than age‐and sex‐matched controls and had more negative attribution of negative emotion. These changes may potentially contribute to the psychosocial burden and social stigma associated with TED. Early targeted interventions, including botulinum toxin, should be considered in appropriately selected patients.