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Thyroid-Associated Orbitopathy
Bronwyn E. Hamilton, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Graves ophthalmopathy, thyroid eye disease
            • Definitions

              • Autoimmune orbital inflammatory condition associated with autoimmune thyroid dysfunction

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              • Reporting Tips

                                                Selected References

                                                1. Cohen LM et al: Radiographic analysis of fatty infiltration of the extraocular muscles in thyroid eye disease. Orbit. ePub, 2020
                                                2. Feeney C et al: Non-EPI-DWI for detection, disease monitoring, and clinical decision-making in thyroid eye disease. AJNR Am J Neuroradiol. 41(8):1466-72, 2020
                                                3. Starks VS et al: Visual field and orbital computed tomography correlation in dysthyroid optic neuropathy due to thyroid eye disease. Orbit. 39(2):77-83, 2020
                                                4. Ugradar S et al: Orbital fat expansion in thyroid eye disease is related to age. Eur J Ophthalmol. 30(5):1004-7, 2020
                                                5. Wang Y et al: Thyroid eye disease presenting with superior rectus/levator complex enlargement. Orbit. 39(1):5-12, 2020
                                                6. Cyranska-Chyrek E et al: Severe unilateral orbitopathy in a patient with Hashimoto's thyroiditis - a case report. BMC Ophthalmol. 19(1):9, 2019
                                                7. Del Porto L et al: Superior oblique enlargement in thyroid eye disease. J AAPOS. 23(5):252.e1-252.e4, 2019
                                                8. Jamshidian-Tehrani M et al: Color Doppler imaging in thyroid eye disease and its correlation to disease activity. Orbit. 38(6):440-5, 2019
                                                9. Oropesa S et al: Predominant contribution of superior rectus-levator complex enlargement to optic neuropathy and inferior visual field defects in thyroid eye disease. Ophthalmic Plast Reconstr Surg. 35(3):262-5, 2019
                                                10. Tooley AA et al: Distinguishing IgG4-related ophthalmic disease from graves orbitopathy. Ophthalmic Plast Reconstr Surg. 35(2):170-6, 2019
                                                11. Erdei A et al: Exophthalmos in a young woman with no graves' disease - a case report of IgG4-related orbitopathy. BMC Ophthalmol. 18(1):5, 2018
                                                12. Guo J et al: Computed tomography measurements as a standard of exophthalmos? Two-dimensional versus three-dimensional techniques. Curr Eye Res. 43(5):647-53, 2018
                                                13. Neuman D et al: Marine-Lenhart syndrome: case report, diagnosis, and management. Case Rep Endocrinol. 2018:3268010, 2018
                                                14. grBoddu N et al: Not all orbitopathy is Graves': discussion of cases and review of literature. Front Endocrinol (Lausanne). 8:184, 2017
                                                15. Davies MJ et al: Levator muscle enlargement in thyroid eye disease-related upper eyelid retraction. Ophthalmic Plast Reconstr Surg. 33(1):35-9, 2017
                                                16. Shafi F et al: The enlarged extraocular muscle: to relax, reflect or refer? Eye (Lond). 31(4):537-44, 2017
                                                17. Perumal B et al: Treatment of severe thyroid eye disease: a survey of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). Ophthal Plast Reconstr Surg. 31(2):127-31, 2015
                                                18. Shan SJ et al: The pathophysiology of thyroid eye disease. J Neuroophthalmol. 34(2):177-85, 2014
                                                19. Borumandi F et al: Classification of orbital morphology for decompression surgery in Graves' orbitopathy: two-dimensional versus three-dimensional orbital parameters. Br J Ophthalmol. 97(5):659-62, 2013
                                                20. Dolman PJ et al: Orbital radiotherapy for thyroid eye disease. Curr Opin Ophthalmol. 23(5):427-32, 2012
                                                21. Bahn RS: Graves' ophthalmopathy. N Engl J Med. 362(8):726-38, 2010
                                                22. Hu WD et al: Radiographic analysis of extraocular muscle volumetric changes in thyroid-related orbitopathy following orbital decompression. Ophthal Plast Reconstr Surg. 26(1):1-6, 2010
                                                23. Bartalena L et al: Clinical practice. Graves' ophthalmopathy. N Engl J Med. 360(10):994-1001, 2009
                                                24. Dodds NI et al: Use of high-resolution MRI of the optic nerve in Graves' ophthalmopathy. Br J Radiol. 82(979):541-4, 2009
                                                25. Kirsch E et al: Imaging in Graves' orbitopathy. Orbit. 28(4):219-25, 2009
                                                26. Bartalena L et al: Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol. 158(3):273-85, 2008
                                                27. Bijlsma WR et al: Radiologic measurement of extraocular muscle volumes in patients with Graves' orbitopathy: a review and guideline. Orbit. 25(2):83-91, 2006
                                                28. Dolman PJ et al: VISA Classification for Graves orbitopathy. Ophthal Plast Reconstr Surg. 22(5):319-24, 2006
                                                29. Cakirer S et al: Evaluation of extraocular muscles in the edematous phase of Graves ophthalmopathy. J Comput Assist Tomogr. 28(1):80-6, 2004
                                                30. Bahn RS: Thyrotropin receptor expression in orbital adipose/connective tissues from patients with thyroid-associated ophthalmopathy. Thyroid. 12(3):193-5, 2002
                                                31. Yokoyama N et al: Role of magnetic resonance imaging in the assessment of disease activity in thyroid-associated ophthalmopathy. Thyroid. 12(3):223-7, 2002
                                                32. Mayer E et al: Serial STIR magnetic resonance imaging correlates with clinical score of activity in thyroid disease. Eye. 15(Pt 3):313-8, 2001
                                                33. Alp MN et al: Colour Doppler imaging of the orbital vasculature in Graves' disease with computed tomographic correlation. Br J Ophthalmol. 84(9):1027-30, 2000
                                                34. Ozgen A et al: Normative measurements of orbital structures using CT. AJR Am J Roentgenol. 170(4):1093-6, 1998
                                                35. Weber AL et al: Graves' disease of the orbit. Neuroimaging Clin N Am. 6(1):61-72, 1996
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Graves ophthalmopathy, thyroid eye disease
                                                          • Definitions

                                                            • Autoimmune orbital inflammatory condition associated with autoimmune thyroid dysfunction

                                                          IMAGING

                                                          • General Features

                                                            • CT Findings

                                                              • MR Findings

                                                                • Ultrasonographic Findings

                                                                  • Nuclear Medicine Findings

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Staging, Grading, & Classification

                                                                            • Gross Pathologic & Surgical Features

                                                                              • Microscopic Features

                                                                                CLINICAL ISSUES

                                                                                • Presentation

                                                                                  • Demographics

                                                                                    • Natural History & Prognosis

                                                                                      • Treatment

                                                                                        DIAGNOSTIC CHECKLIST

                                                                                        • Consider

                                                                                          • Image Interpretation Pearls

                                                                                            • Reporting Tips

                                                                                              Selected References

                                                                                              1. Cohen LM et al: Radiographic analysis of fatty infiltration of the extraocular muscles in thyroid eye disease. Orbit. ePub, 2020
                                                                                              2. Feeney C et al: Non-EPI-DWI for detection, disease monitoring, and clinical decision-making in thyroid eye disease. AJNR Am J Neuroradiol. 41(8):1466-72, 2020
                                                                                              3. Starks VS et al: Visual field and orbital computed tomography correlation in dysthyroid optic neuropathy due to thyroid eye disease. Orbit. 39(2):77-83, 2020
                                                                                              4. Ugradar S et al: Orbital fat expansion in thyroid eye disease is related to age. Eur J Ophthalmol. 30(5):1004-7, 2020
                                                                                              5. Wang Y et al: Thyroid eye disease presenting with superior rectus/levator complex enlargement. Orbit. 39(1):5-12, 2020
                                                                                              6. Cyranska-Chyrek E et al: Severe unilateral orbitopathy in a patient with Hashimoto's thyroiditis - a case report. BMC Ophthalmol. 19(1):9, 2019
                                                                                              7. Del Porto L et al: Superior oblique enlargement in thyroid eye disease. J AAPOS. 23(5):252.e1-252.e4, 2019
                                                                                              8. Jamshidian-Tehrani M et al: Color Doppler imaging in thyroid eye disease and its correlation to disease activity. Orbit. 38(6):440-5, 2019
                                                                                              9. Oropesa S et al: Predominant contribution of superior rectus-levator complex enlargement to optic neuropathy and inferior visual field defects in thyroid eye disease. Ophthalmic Plast Reconstr Surg. 35(3):262-5, 2019
                                                                                              10. Tooley AA et al: Distinguishing IgG4-related ophthalmic disease from graves orbitopathy. Ophthalmic Plast Reconstr Surg. 35(2):170-6, 2019
                                                                                              11. Erdei A et al: Exophthalmos in a young woman with no graves' disease - a case report of IgG4-related orbitopathy. BMC Ophthalmol. 18(1):5, 2018
                                                                                              12. Guo J et al: Computed tomography measurements as a standard of exophthalmos? Two-dimensional versus three-dimensional techniques. Curr Eye Res. 43(5):647-53, 2018
                                                                                              13. Neuman D et al: Marine-Lenhart syndrome: case report, diagnosis, and management. Case Rep Endocrinol. 2018:3268010, 2018
                                                                                              14. grBoddu N et al: Not all orbitopathy is Graves': discussion of cases and review of literature. Front Endocrinol (Lausanne). 8:184, 2017
                                                                                              15. Davies MJ et al: Levator muscle enlargement in thyroid eye disease-related upper eyelid retraction. Ophthalmic Plast Reconstr Surg. 33(1):35-9, 2017
                                                                                              16. Shafi F et al: The enlarged extraocular muscle: to relax, reflect or refer? Eye (Lond). 31(4):537-44, 2017
                                                                                              17. Perumal B et al: Treatment of severe thyroid eye disease: a survey of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). Ophthal Plast Reconstr Surg. 31(2):127-31, 2015
                                                                                              18. Shan SJ et al: The pathophysiology of thyroid eye disease. J Neuroophthalmol. 34(2):177-85, 2014
                                                                                              19. Borumandi F et al: Classification of orbital morphology for decompression surgery in Graves' orbitopathy: two-dimensional versus three-dimensional orbital parameters. Br J Ophthalmol. 97(5):659-62, 2013
                                                                                              20. Dolman PJ et al: Orbital radiotherapy for thyroid eye disease. Curr Opin Ophthalmol. 23(5):427-32, 2012
                                                                                              21. Bahn RS: Graves' ophthalmopathy. N Engl J Med. 362(8):726-38, 2010
                                                                                              22. Hu WD et al: Radiographic analysis of extraocular muscle volumetric changes in thyroid-related orbitopathy following orbital decompression. Ophthal Plast Reconstr Surg. 26(1):1-6, 2010
                                                                                              23. Bartalena L et al: Clinical practice. Graves' ophthalmopathy. N Engl J Med. 360(10):994-1001, 2009
                                                                                              24. Dodds NI et al: Use of high-resolution MRI of the optic nerve in Graves' ophthalmopathy. Br J Radiol. 82(979):541-4, 2009
                                                                                              25. Kirsch E et al: Imaging in Graves' orbitopathy. Orbit. 28(4):219-25, 2009
                                                                                              26. Bartalena L et al: Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol. 158(3):273-85, 2008
                                                                                              27. Bijlsma WR et al: Radiologic measurement of extraocular muscle volumes in patients with Graves' orbitopathy: a review and guideline. Orbit. 25(2):83-91, 2006
                                                                                              28. Dolman PJ et al: VISA Classification for Graves orbitopathy. Ophthal Plast Reconstr Surg. 22(5):319-24, 2006
                                                                                              29. Cakirer S et al: Evaluation of extraocular muscles in the edematous phase of Graves ophthalmopathy. J Comput Assist Tomogr. 28(1):80-6, 2004
                                                                                              30. Bahn RS: Thyrotropin receptor expression in orbital adipose/connective tissues from patients with thyroid-associated ophthalmopathy. Thyroid. 12(3):193-5, 2002
                                                                                              31. Yokoyama N et al: Role of magnetic resonance imaging in the assessment of disease activity in thyroid-associated ophthalmopathy. Thyroid. 12(3):223-7, 2002
                                                                                              32. Mayer E et al: Serial STIR magnetic resonance imaging correlates with clinical score of activity in thyroid disease. Eye. 15(Pt 3):313-8, 2001
                                                                                              33. Alp MN et al: Colour Doppler imaging of the orbital vasculature in Graves' disease with computed tomographic correlation. Br J Ophthalmol. 84(9):1027-30, 2000
                                                                                              34. Ozgen A et al: Normative measurements of orbital structures using CT. AJR Am J Roentgenol. 170(4):1093-6, 1998
                                                                                              35. Weber AL et al: Graves' disease of the orbit. Neuroimaging Clin N Am. 6(1):61-72, 1996