Asymmetric Graves’ Orbitopathy

Panagiotou, Grigorios; Perros, Petros

doi:10.3389/fendo.2020.611845

Cited by 18 publications

(18 citation statements)

References 45 publications

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“…While non-EO CT scans are highly symmetrical, the situation in EO is different. Globe asymmetry (i.e.more than 2 mm difference [36], has been shown to indicate a more severe and active disease [37]. Thus, 3D-cephalometry and the respective analysis would be the ideal means to exactly analyze the extent and progress of EO to decide on appropriate therapeutic means.…”

Section: Plos Onementioning

confidence: 99%

3-D cephalometry of the the orbit regarding endocrine orbitopathy, exophthalmos, and sex

et al. 2022

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Purpose This study aimed at evaluating the orbital anatomy of patients concerning the relevance of orbital anatomy in the etiology of EO (endocrine orbitopathy) and exophthalmos utilizing a novel approach regarding three-dimensional measurements. Furthermore, sexual dimorphism in orbital anatomy was analyzed. Methods Orbital anatomy of 123 Caucasian patients (52 with EO, 71 without EO) was examined using computed tomographic data and FAT software for 3-D cephalometry. Using 56 anatomical landmarks, 20 angles and 155 distances were measured. MEDAS software was used for performing connected and unconnected t-tests and Spearman´s rank correlation test to evaluate interrelations and differences. Results Orbital anatomy was highly symmetrical with a mean side difference of 0.3 mm for distances and 0.6° for angles. There was a small albeit statistically significant difference in 13 out of 155 distances in women and 1 in men concerning patients with and without EO. Two out of 12 angles showed a statistically significant difference between female patients with and without EO. Regarding sex, statistically significant differences occurred in 39 distances, orbit volume, orbit surface, and 2 angles. On average, measurements were larger in men. Concerning globe position within the orbit, larger distances to the orbital apex correlated with larger orbital dimensions whereas the sagittal position of the orbital rim defined Hertel values. Conclusion In this study, little difference in orbital anatomy between patients with and without EO was found. Concerning sex, orbital anatomy differed significantly with men presenting larger orbital dimensions. Regarding clinically measured exophthalmos, orbital aperture anatomy is an important factor which has to be considered in distinguishing between true exophthalmos with a larger distance between globe and orbital apex and pseudoexophthalmos were only the orbital rim is retruded. Thus, orbital anatomy may influence therapy regarding timing and surgical procedures as it affects exophthalmos.

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Section: Plos Onementioning

confidence: 99%

3-D cephalometry of the the orbit regarding endocrine orbitopathy, exophthalmos, and sex

et al. 2022

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“…TED is a frequent complication of GD, with recent evidence estimating a prevalence of 25–50% of this complication in GD ( 1 ). Unilateral TED is seen in nearly 4–14% of cases but most cases with clinically unilateral disease are confirmed to have bilateral disease radiologically ( 2 ). However, upto 7% patients may be euthyroid, and on the other hand, non-TED inflammatory and neoplastic conditions can cause ocular involvement in a patient of GD ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, upto 7% patients may be euthyroid, and on the other hand, non-TED inflammatory and neoplastic conditions can cause ocular involvement in a patient of GD ( 3 ). Further, asymmetric involvement has been reported in 9–34% cases, but most cases classify as mild asymmetry ( 2 ). In the spectrum of TED, disease activity and severity do not always go hand in hand.…”

Section: Discussionmentioning

confidence: 99%

“…Thyroid eye disease (TED) is a frequent complication of Graves’ disease (GD) ( 1 ). It is usually synchronous and bilateral but may be clinically unilateral in upto 4–14% of cases ( 2 ). However, non-TED causes of ocular involvement must be suspected in patients with atypical features such as non-axial (eccentric) proptosis (defined as protrusion of the eyeball with an alignment different from the long axis of the globe, in which the direction is determined by the site of the lesion) and a lack of lid retraction in elderly individuals.…”

Section: Introductionmentioning

confidence: 99%

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Thyroid eye disease with concurrent orbital lymphoma: a radiological surprise

Das

Singh

Malhotra

et al. 2022

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Thyroid eye disease (TED) is the most common extra-thyroidal manifestation in Graves’ disease (GD). Additional/concurrent/synchronous pathologies may be present, especially in elderly patients who present with atypical features such as non-axial (or eccentric) proptosis, absence of lid lag and restricted superior extra-ocular movements. A 70-year-old female presented with progressive proptosis of her left eye and diplopia. She was diagnosed with GD a year prior and initiated on carbimazole. On examination, she had eccentric proptosis, restricted superior extra-ocular movements and a palpable mass in the supero-temporal quadrant of the left eye. Her T3 (1.33 ng/mL) and T4 (8.85 µg/dL) were normal with carbimazole. Thyroid-stimulating hormone (TSH)-receptor antibody was positive (3.15 IU/L, reference range <1.75). MRI revealed an enhancing lesion infiltrating the left superior rectus, with concurrent characteristic muscle belly involvement bilaterally. Orbital biopsy showed atypical lymphoid cells (CD20+), suggesting marginal zone lymphoma. CT thorax and abdomen, fluorodeoxyglucose-positron emission tomography and bone marrow examination were normal. The patient was administered orbital radiotherapy for her localised lymphoma and carbimazole was continued. TED is the most common cause of orbital involvement overall and in GD. However, additional or alternative pathology may be present which requires evaluation. MRI can be a useful adjunct in these patients. Orbital lymphoma needs to be staged with workup for disseminated disease. Radiotherapy is the treatment of choice for localized disease. The index case provides evidence for synchronous presentation of dual pathology and highlights the importance of astute clinical examination as well as keeps a low threshold for MRI in selected cases. Learning points Thyroid eye disease can co-exist with other ocular pathology, especially in elderly individuals. Eccentric proptosis, absent lid lag and restriction of eye movements (suggesting tendon involvement) should alert towards the presence of alternative pathology. Orbital imaging using MRI not only has greater sensitivity in diagnosing radiologically bilateral disease in patients who have unilateral involvement clinically but is also useful to identify concurrent neoplasms.

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“…Graves' disease (GD) is a common autoimmune thyroid condition in which 25–50% of patients also develop Graves’ orbitopathy (GO), which is a heterogeneous disease resulting from autoimmune attack on the different structures of the orbit ( 1 ). GO can manifest as swelling of the soft tissues of the eyelids or the orbital connective tissues and fat leading to proptosis.…”

Section: Introductionmentioning

confidence: 99%

A rare case of severe bilateral Graves’ orbitopathy involving an anophthalmic socket

Ali

Abouzaid

Clarke

et al. 2023

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary This is a report of a rare case of Graves’ hyperthyroidism associated with severe bilateral Graves’ orbitopathy, in a patient with an anophthalmic eye socket. On clinical review her prosthetic eye (left eye) was tilting upwards, along with worsening of Graves’ orbitopathy (GO) in the only seeing eye. As she refused IV glucocorticoids, she was offered rituximab which only caused a transient improvement in the clinical activity score of the eye. She had persistent right upper lid retraction of 6 mm, associated with lagophthalmos. To protect her seeing eye from corneal ulceration, the patient received a botulinum toxin injection to the right upper eyelid to induce blepharoptosis as an interim measure prior to right upper eyelid blepharotomy in April 2021. This patient remains biochemically euthyroid on block and replace therapy and her TRAb level is falling over time. Treatment for active GO is ongoing and the patient required a redo blepharotomy for painful corneal exposure in the right eye. Learning points Graves’ orbitopathy (GO) does not actually primarily affect the eyeball itself but the orbital contents as well. Patients with severe GO in an only seeing-eyed patient should be referred early to a multidisciplinary Joint Thyroid Eye clinic for expert review and management. Patient outcomes including sight loss are likely to be improved by the extended range of medical and surgical treatment modalities available at specialist clinics treating GO, including the use of immunomodulatory drugs like rituximab or teprotumumab.

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Asymmetric Graves’ Orbitopathy

Cited by 18 publications

References 45 publications

3-D cephalometry of the the orbit regarding endocrine orbitopathy, exophthalmos, and sex

3-D cephalometry of the the orbit regarding endocrine orbitopathy, exophthalmos, and sex

Thyroid eye disease with concurrent orbital lymphoma: a radiological surprise

A rare case of severe bilateral Graves’ orbitopathy involving an anophthalmic socket

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