Abstract
Graves’ disease is an autoimmune disorder characterized by thyroid gland hyperplasia and excessive production of thyroid hormones [1]. Involvement of the eye, also known as Graves’ Ophthalmopathy or Thyroid Eye Disease (TED) is the most common extrathyroidal manifestation of Graves’ disease [2]. TED results from infiltration of the orbital soft tissues with autoreactive T lymphocytes, proliferation of orbital fibroblasts, and increased adipocytes [3]. Clinically recognizable TED has been reported to occur in 25–50% of GD patients, and sight-threatening disease in 3–5% cases in the Western literature [4]. The diagnosis of TED is usually based on obvious clinical findings such as lid retraction and unilateral or bilateral proptosis in a person with systemic thyroid dysfunction [5]. Orbital imaging aids in ruling out the differential diagnosis, to assess disease activity (MRI), and surgical planning prior to orbital decompression [5]. It has been shown that orbital imaging reveals abnormalities in 90% of patients with Graves’ disease [6].
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Brent GA. Clinical practice. Graves’ disease. N Engl J Med. 2008;358:2594–605.
Bartalena L, Tanda ML. Clinical practice. Graves’ ophthalmopathy. N Engl J Med. 2009;360:994–1001.
Naik VM, Naik MN, Goldberg RA, Smith TJ, Douglas RS. Immunopathogenesis of thyroid eye disease: emerging paradigms. Surv Ophthalmol. 2010;55:215–26.
Stan MN, Bahn RS. Risk factors for development or deterioration of graves’ ophthalmopathy. Thyroid. 2010;20:777–83.
Dickinson AJ. Clinical manifestations. In: Wiersinga WM, Kahaly GJ, editors. Graves’ orbitopathy: a multidisciplinary approach–questions and answers. 2nd ed. Basel: Karger; 2010. p. 1–25.
Müller-Forell W, Pitz S, Mann W, et al. Neuroradiological diagnosis of thyroid-associated orbitopathy. Exp Clin Endocrinol Diabetes. 1999;107:177–83.
Bartalena L, Pinchera A, Marcocci C. Management of Graves’ ophthalmopathy: reality and perspectives. Endocr Rev. 2000;21:168–99.
Weetman AP, Wiersinga WM. Current management of thyroid- associated ophthalmopathy in Europe. Results of an international survey. Clin Endocrinol. 1998;49:21–8.
Naik MN, Tourani KL, Sekhar GC, Honavar SG. Interpretation of computed tomography imaging of the eye and orbit. A systematic approach. Indian J Ophthalmol. 2002 Dec;50(4):339–53.
Ohnesorge B, Flohr T, Schaller S, et al. Principles and applications of multi-slice CT. Radiology. 1999;11:923–31.
Wichmann W. Magnetic resonance imaging (MRI). In: Müller-Forell W, editor. Imaging of orbital and visual pathway pathology. Heidelberg: Springer; 2002.
Hosten N, Sander B, Cordes M, et al. Graves’ophthalmopathy: MR imaging of the orbits. Radiology. 1989;172:759–62.
Prummel M, Suttorp-Schulten M, Wiersinga WM, et al. A new ultrasonographic method to detect disease activity and predict response to immunosuppressive treatment in graves’ ophthalmopathy. Ophthalmology. 1993;100:556–61.
Kahaly GJ. Recent developments in graves’ ophthalmology imaging. J Endocrinol Investig. 2004;27:254–8.
Krassas GE, Kahaly GJ. The role of octreoscan in thyroid eye disease. Eur J Endocrinol. 1999;140:373–5.
Förster GJ, Krummenauer F, Nickel O, Kahaly GJ. Somatostatin-receptor scintigraphy in graves’ disease: reproducibility and variance of orbital activity. Cancer Biother Radiopharm. 2000 Oct;15(5):517–25.
Mourits MP. Diagnosis and differential diagnosis of graves’ orbitopathy. In: Wiersinga WM, Kahaly GJ, editors. Graves’ orbitopathy: a multidisciplinary approach–questions and answers. 2nd ed. Basel: Karger; 2010. p. 66–76.
Peyster RG, Hoover ED. Graves’ orbitopathy. In: Peyster RG, Hoover ED, editors. Computerized tomography in orbital diseases and neuro-ophthalmology. Chicago: Year Book Medical Publishers; 1984. p. 97–114.
Hilal SK, Trokel SL. Computerized tomography of the orbit using thin sections. Semin Roentgenol. 1977;12:137–47.
Strianese D, Piscopo R, Elefante A, et al. Unilateral proptosis in thyroid eye disease with subsequent contralateral involvement: retrospective follow-up study. BMC Ophthalmol. 2013;13:21.
Dallow RL. Evaluation of unilateral exophthalmos with ultrasonography: analysis of 258 consecutive cases. Laryngoscope. 1975;85(11 pt 1):1905–19.
Flanders AE, Mafee MF, Metal RV. CT characteristics of orbital pseudotumors and other orbital inflammatory processes. J Comput Assist Tomogr. 1989;13:40–7.
Kirsch E, Hammer B, von Arx G. Graves’orbitopathy: current imaging procedures. Swiss Med Wkly. 2009;139:618–23.
Regensburg NI, Wiersinga WM, Berendschot TT, et al. Densities of orbital fat and extraocular muscles in graves orbitopathy patients and controls. Ophthal Plast Reconstr Surg. 2011;27:236–40.
Hiromatsu Y, Kojima K, Ishisaka N, et al. Role of magnetic resonance imaging in thyroid-associated ophthalmopathy: its predictive value for therapeutic outcome of immunosuppressive therapy. Thyroid. 1992;2:299–305.
Hoh HB, Laitt RD, Wakeley C, et al. The STIR sequence MRI in the assessment of extraocular muscles in thyroid eye disease. Eye (Lond). 1994;8(pt 5):506–10.
Jiang H, Wang Z, Xian J, et al. Evaluation of rectus extraocular muscles using dynamic contrast-enhanced MR imaging in patients with graves’ ophthalmopathy for assessment of disease activity. Acta Radiol. 2012;53:87–94.
Barrett L, Glatt HJ, Burde RM, et al. Optic nerve dysfunction in thyroid eye disease: CT. Radiology. 1988;167:503–7.
Nugent RA, Belkin RI, Neigel JM, et al. Graves orbitopathy: correlation of CT and clinical findings. Radiology. 1990;177:675–82.
Birchall D, Goodall KL, Noble JL, et al. Graves ophthalmopathy: intracranial fat prolapse on CT images as an indicator of optic nerve compression. Radiology. 1996;200:123–7.
Trokel SL, Jakobiec FA. Correlation of CT scanning and pathologic features of ophthalmic Graves’ disease. Ophthalmology. 1981;88:553–64.
Yokoyama N, Nagataki S, Uetani M, et al. Role of magnetic resonance imaging in the assessment of disease activity in thyroid-associated ophthalmopathy. Thyroid. 2002;12:223–7.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Naik, M.N. (2020). Orbital Imaging for Orbital Decompression. In: Rath, S., Naik, M. (eds) Surgery in Thyroid Eye Disease. Springer, Singapore. https://doi.org/10.1007/978-981-32-9220-8_3
Download citation
DOI: https://doi.org/10.1007/978-981-32-9220-8_3
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-32-9219-2
Online ISBN: 978-981-32-9220-8
eBook Packages: MedicineMedicine (R0)