99mTc-DTPA SPECT/CT provided guide on triamcinolone therapy in Graves’ ophthalmopathy patients

  • Dan Liu
  • Xueliang Xu
  • Sha Wang
  • Chengzhi Jiang
  • Xinhui Li
  • Jia TanEmail author
  • Zhihong DengEmail author
Original Paper



Distinguishing between the active and inactive stages of Graves’ ophthalmopathy (GO) is essential for making treatment decisions. 99mTc-DTPA SPECT/CT is sensitive in identifying inflammation in extraocular muscles of GO patients, which we designate 99mTc-DTPA-active. This study aimed to evaluate the response of 99mTc-DTPA-active GO patients to local immunosuppressive therapy.

Materials and methods

Sixty-four 99mTc-DTPA-active GO patients (89 eyes) were retrospectively analyzed. Forty-five patients (64 eyes) received repeated peribulbar triamcinolone injection, and 19 patients (25 eyes) received no immunosuppressive treatment. Ophthalmological assessment, including clinical activity score, eyelid retraction, eyelid aperture, proptosis, diplopia, and ocular mobility, was recorded before and after treatment.


Compared with untreated patients, the clinical activity score decreased significantly (P  < 0.001) while eye symptoms (soft-tissue swelling and eyelid retraction and aperture) improved significantly (P  = 0.02, P  < 0.001, P  < 0.001, respectively) in treated patients after six months. The inferior and medial recti were significantly smaller (P  < 0.001, P  < 0.001, respectively), and 99mTc-DTPA uptake in the two recti was significantly less (P  = 0.001, P  = 0.01, respectively) in treated patients than in untreated patients after 3 months.


Clinical activity score of < 3 does not indicate inactive GO, as revealed with 99mTc-DTPA SPECT/CT. Patients with 99mTc-DTPA-active GO can improve the symptoms with peribulbar triamcinolone injection.


Triamcinolone Graves’ ophthalmopathy SPECT/CT 


Compliance with ethical standards

Conflict of interest

No conflict of interest


This study was supported by Hunan Provincial Natural Science Foundation (No. 2019JJ80012).

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Bahn RS (2010) Graves’ ophthalmopathy. N Engl J Med 362(8):726–738CrossRefGoogle Scholar
  2. 2.
    Dolman PJ (2012) Evaluating Graves’ orbitopathy. Best Pract Res Clin Endocrinol Metab 26(3):229–248CrossRefGoogle Scholar
  3. 3.
    Tong BD et al (2015) MiRNA-21 promotes fibrosis in orbital fibroblasts from thyroid-associated ophthalmopathy. Mol Vis 21:324–334PubMedGoogle Scholar
  4. 4.
    Menconi F, Profilo MA, Leo M et al (2014) Spontaneous improvement of untreated mild Graves’ ophthalmopathy: Rundle’s curve revisited. Thyroid 24(1):60–66CrossRefGoogle Scholar
  5. 5.
    Bartley GB (1994) The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota. Trans Am Ophthalmol Soc 92:477–588PubMedPubMedCentralGoogle Scholar
  6. 6.
    Bartalena L, Baldeschi L, Boboridis K et al (2016) The 2016 European Thyroid Association/European Group on Graves’ orbitopathy guidelines for the management of graves’ orbitopathy. Eur Thyroid J 5(1):9–26CrossRefGoogle Scholar
  7. 7.
    Mourits MP, Koornneef L, Wiersinga WM, Prummel MF, Berghout A, van der Gaag R (1989) Clinical criteria for the assessment of disease activity in Graves’ ophthalmopathy: a novel approach. Br J Ophthalmol 73(8):639–644CrossRefGoogle Scholar
  8. 8.
    Savku E, Gündüz K (2015) Diagnosis, follow-up and treatment results in thyroid ophthalmopathy. Turk J Ophthalmol 45(4):156–163CrossRefGoogle Scholar
  9. 9.
    Wu Y, Tong B, Luo Y, Xie G, Xiong W (2015) Effect of radiotherapy on moderate and severe thyroid associated ophthalmopathy: a double blind and self-controlled study. Int J Clin Exp Med 8(2):2086–2096PubMedPubMedCentralGoogle Scholar
  10. 10.
    Wu YJ, Wei X, Xiao MY, Xiong W (2016) Orbital decompression surgery and horse chestnut seed extract improved superior orbital vein blood flow in patients with thyroid-associated ophthalmopathy. Int J Ophthalmol 9(6):869–875PubMedPubMedCentralGoogle Scholar
  11. 11.
    Mourits MP, Prummel MF, Wiersinga WM, Koornneef L (1997) Clinical activity score as a guide in the management of patients with Graves’ ophthalmopathy. Clin Endocrinol (Oxf) 47(1):9–14CrossRefGoogle Scholar
  12. 12.
    Tachibana S, Murakami T, Noguchi H, Noguchi Y, Nakashima A, Ohyabu Y, Noguchi S (2010) Orbital magnetic resonance imaging combined with clinical activity score can improve the sensitivity of detection of disease activity and prediction of response to immunosuppressive therapy for Graves’ ophthalmopathy. Endocr J 57(10):853–861CrossRefGoogle Scholar
  13. 13.
    Galuska László, Barna Sándor K, Varga József, Garai Ildikó, Nagy Endre V (2018) The role of 99mTc-DTPA retrobulbar SPECT in staging and follow-up of Graves’ orbitopathy. Nucl Med Rev 21(1):54–58CrossRefGoogle Scholar
  14. 14.
    Galuska L, Leovey A, Szucs-Farkas Z, Garai I, Szabo J, Varga J, Nagy EV (2002) SPECT using 99mTc-DTPA for the assessment of disease activity in Graves’ ophthalmopathy: a comparison with the results from MRI. Nucl Med Commun 23(12):1211–1216CrossRefGoogle Scholar
  15. 15.
    Szabados L, Nagy EV, Ujhelyi B, Urbancsek H, Varga J, Nagy E, Galuska L (2013) The impact of 99mTc-DTPA orbital SPECT in patient selection for external radiation therapy in Graves’ ophthalmopathy. Nucl Med Commun 34(2):108–112CrossRefGoogle Scholar
  16. 16.
    Galuska L, Leovey A, Szucs-Farkas Z, Szabados L, Garai I, Berta A, Balazs E, Varga J, Nagy EV (2005) Imaging of disease activity in Graves’ orbitopathy with different methods: comparison of (m)Tc-DTPA and (m)Tc-depreotide single photon emission tomography, magnetic resonance imaging and clinical activity scores. Nucl Med Commun 26(5):407–414CrossRefGoogle Scholar
  17. 17.
    Bahn RS, Heufelder AE (1993) Pathogenesis of Graves’ ophthalmopathy. N Engl J Med 329:1468–1475CrossRefGoogle Scholar
  18. 18.
    Bordaberry M et al (2009) Repeated peribulbar injections of triamcinolone acetonide: a successful and safe treatment for moderate to severe Graves’ ophthalmopathy. Acta Ophthalmol 87(1):58–64CrossRefGoogle Scholar
  19. 19.
    Alkawas AA, Hussein AM, Shahien EA (2010) Orbital steroid injection versus oral steroid therapy in management of thyroid-related ophthalmopathy. Clin Exp Ophthalmol 38:692–697CrossRefGoogle Scholar
  20. 20.
    Lee SJ et al (2013) Treatment of upper eyelid retraction related to thyroid-associated ophthalmopathy using subconjunctival triamcinolone injections. Graefes Arch Clin Exp Ophthalmol 251(1):261–270CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of OphthalmologyXiangya Hospital Central South UniversityChangshaChina
  2. 2.Department of Nuclear Medicine, Xiangya HospitalCentral South UniversityChangshaChina
  3. 3.Department of Ophthalmology, The Third Xiangya HospitalCentral South UniversityChangshaChina

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