Orbital MRI in thyroid-associated orbitopathy

Year 2022, , 133 - 137, 29.03.2022

Muhammed Akif Deniz , Mehmet Turmak , Zafer Pekkolay , Salih Hattapoğlu

https://doi.org/10.38053/acmj.1053429

Abstract

Aim: Thyroid-associated orbitopathy (TAO) is the most common cause of proptosis in adults and the clinical picture is mostly associated with thyroid dysfunction. MRI is frequently used because of its advantages, such as high soft tissue resolution, multiple plane evaluation, and no risk of ionizing radiation exposure to the lens. The research aim was to present cases of thyroid orbitopathy with MRI findings and to compare the findings with existing literature.
Material and Method: Patients who visited our radiology clinic with a preliminary diagnosis of TAO between April 2015 and February 2021 and underwent orbital MRIs were included in the study. We evaluated parameters such as age, sex, presence of proptosis, orbital muscle involvement, increase in orbital fatty tissue, and lacrimal gland involvement.
Results:A total of 35 patients were included in our study. The mean age was 40.6 (18-60) years, 19 (54%) patients were female, and 16 (46%) were male. All patients were diagnosed with Graves’ disease, whereas no patient was diagnosed with Hashimoto’s thyroiditis. The most common findings were proptosis in 33 (94%) patients, inferior rectus involvement in 27 (77%) patients, and medial rectus muscle involvement in 25 (71%) patients. No significant correlation was found between the presence of uni/bilateral involvement and TSH values (p = 0.008).
Conclusion: In conclusion, since the presence of orbital involvement is crucial for treating thyroid diseases, all orbital structures involved should be reported by imaging. Orbital MRI is an effective imaging modality in the detection and differential diagnosis of TAO.

Keywords

Thyroid, Orbita, Proptozis, Magnetic Resonance Imaging

References

• Ginsberg J. Diagnosis and management of Graves’ disease. CMAJ 2003; 168: 575-585.
• Chan LL, Tan HE, Teo F.T-H, L-H Lim, Seah L. Graves ophthalmopathy: the bony orbit in optic neuropathy, its apical angular capacity, and impact on prediction of risk. AJNR Am J Neuroradiol 2009; 30: 597-602.
• North VS, Freitag SK. A review of imaging modalities in thyroid-associated orbitopathy. Int Ophthalmol Clin 2019; 59: 81-93.
• Mishra S, Maurya VK, Kumar SA, Kaur A, Saxena SK. Clinical management and therapeutic strategies for the thyroid-associated ophthalmopathy: current and future perspectives. Curr Eye Res 2020; 45: 1325-41.
• Bartalena L, Marcocci C, Pinchera A. Graves’ ophthalmopathy: a preventable disease? Eur J Endocrinol 2002; 146: 457.
• Şanlı E. Gündüz K. Tiroid Oftalmopati. Turk J Ophthalmol 2017; 47: 94-105
• Davies MJ, Dolman PJ. Levator muscle enlargement in thyroid eye disease-related upper eyelid retraction. Ophthalmic Plast Reconstr Surg 2017: 33: 35-9.
• Parmar H, Ibrahim M. Extrathyroidal manifestations of thyroid disease: thyroid ophthalmopathy. Neuroimaging Clin N Am 2008; 18: 527-36.
• Ahn ES, Subramanian PS. Treatment modalities of thyroid related orbitopathy. Indian J Ophthalmol 2014; 62: 999-1002.
• Hodgson NM, Rajaii F. Current understanding of the progression and management thyroid associated orbitopathy: a systematic review. Ophthalmol Ther 2020; 9: 21-33
• Hennein L, Robbins SL. Thyroid-associated orbitopathy: management and treatment. J Binocul Vis Ocul Motil 2021: 1-15.
• Haaga JR, Boll D. CT and MRI of the whole body. Mosby 2009; 2: 56-65
• Ozgen A, Aydingoz U. Normative measurements of orbital structures using MRI. J Comput Assist Tomogr 2000; 24: 493-6.
• Ozgen A, Ariyurek M. Normative measurements of orbital structures using CT. AJR. 1998; 170: 1093-6.
• Monteiro ML, Gonçalves AC, Silva CT, Moura JP, Ribeiro CS, Gebrim EM. Diagnostic ability of Barrett’s index to detect dysthyroid optic neuropathy using multidetector computed tomography. Clinics 2008; 63: 301-6.
• Bahn RS. Graves’ ophthalmopathy. N Engl J Med 2010; 362: 726-38.
• Eckstein AK, Finkenrath A, Heiligenhaus A. et al. Dry eye syndrome in thyroid-associated ophthalmo- pathy: lacrimal expression of TSH receptor suggests involvement of TSHR-specific autoantibodies. Acta Ophthalmol Scand 2004; 82: 291-7.
• Gagliardo C, Radellini S, Bubella RM, et al. Lacrimal gland herniation in Graves ophthalmopathy: a simple and useful MRI biomarker of disease activity. Eur Radiol 2020; 30: 2138-41