scholarly journals Extraocular muscle problems in thyroid eye disease

Eye ◽  
1994 ◽  
Vol 8 (5) ◽  
pp. 497-505 ◽  
Author(s):  
Peter Fells ◽  
Linda Kousoulides ◽  
Anastasia Pappa ◽  
Peter Munro ◽  
Joanna Lawson
Keyword(s):  
Extraocular Muscle ◽  
Thyroid Eye Disease ◽  
Eye Disease

Correlation Between Extraocular Muscle Size and Motility Restriction in Thyroid Eye Disease

2011 ◽  
Vol 27 (2) ◽  
pp. 102-110 ◽  
Author(s):  
Lora R. Dagi ◽  
Christopher I. Zoumalan ◽  
Hindola Konrad ◽  
Stephen L. Trokel ◽  
Michael Kazim
Keyword(s):  
Extraocular Muscle ◽  
Thyroid Eye Disease ◽  
Muscle Size ◽  
Eye Disease

scholarly journals A Case of Thyroid Eye Disease Revealed During Secondary Adrenal Insufficiency

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A910-A910
Author(s):  
Amira Ibrahim ◽  
Victoria Loseva
Keyword(s):  
Adrenal Insufficiency ◽  
Extraocular Muscle ◽  
Early Recognition ◽  
Thyroid Eye Disease ◽  
Eye Disease ◽  
Secondary Adrenal Insufficiency ◽  
Movement Restriction ◽  
Free T4 ◽  
Muscle Movement ◽  
Graves Orbitopathy

Abstract Introduction: Thyroid eye disease (TED) or Graves’ orbitopathy (GO) is an autoimmune disease of the retro-orbital tissues. GO is mostly associated with hyperthyroidism in 90% of patients; however, it may coexist with hypothyroid conditions in 5% of cases. Clinical Case: A 56-year-old male with a past medical history of autoimmune diseases including hypothyroidism and Ulcerative Colitis on chronic steroid therapy presented to the emergency department with nausea, fatigue, weight loss, and muscle weakness. The patient stated that his glucocorticoids were abruptly discontinued a month prior to his current presentation. On examination, vitals were stable. The patient was somnolent with a depressed mood. He had bilateral periorbital edema and bilateral eyeball protrusion, left more pronounced than right. Extraocular muscle movement revealed a delay in the lateral movement of the left eye causing double vision on exam. He had no starring look or lid lag. The thyroid gland was normal in size and contour. Initial Laboratories revealed a white blood cell count of 6.7 K/mcL (4-10 K/mcL) with 18% eosinophil count (0-5%). Cortisol at 8 AM was 2.9 mcg/dL (4.3 -22.4 mcg/dl). The patient was managed for secondary adrenal insufficiency and restarted immediately on Prednisone. A review of a recent CT scan of the head revealed bilateral proptosis with no signs of compressing lesions. Further thyroid studies revealed TSH of 2.9 mcIU/mL (0.3-3.7 mcIU/mL), free T4 of 0.8 ng/dL (0.75-2.0 ng/dL), free T3 of 1.6 ng/dL (2.4-4.2 ng/dL), TPO antibodies <0.3 IU/mL (0.0-9.0 IU/mL) and TSH receptor antibodies 0.90 IU/L (reference range <1.75 IU/L). The patient was then diagnosed with Hypothyroid Grave’s ophthalmopathy with negative antibodies given the evidence of proptosis on CT and exam revealing extraocular muscle movement restriction causing diplopia. The patient had a unique presentation of TED with hypothyroidism and asymmetric ophthalmic signs that were only manifested after the patient discontinued the prednisone and therefore unmasking the underlying disorder. Fortunately, in June of 2020, the US Food and Drug Administration (FDA) approved Teprotumumab (an insulin-like growth factor 1 [IGF-1] receptor inhibitor) for the treatment of Graves’ orbitopathy based on the findings from two 24-week trials comparing teprotumumab with placebo in 171 patients with active, moderate-to-severe orbitopathy. (1) Our patient was started on Levothyroxine along with Prednisone and referred for ophthalmology evaluation for possible qualification for Teprotumumab treatment. Conclusion: Clinician awareness of the unusual presentations of TED would allow for early recognition and prevention of progression, especially with the recently approved treatment modality. References: (1) Teprotumumab for Thyroid-Associated Ophthalmopathy. Smith TJ Et al. N Engl J Med. 2017;376(18):1748.

scholarly journals Minimization of Extraocular Muscle Damage in Thyroid Eye Disease Patients Following Surgery Based on Computerized Biomechanics

2021 ◽  
Author(s):  
Byeong-Cheol Jeong ◽  
Chi-Seung Lee ◽  
Dong-man Ryu ◽  
Jungyul Park
Keyword(s):  
Finite Element ◽  
Stress Reduction ◽  
Extraocular Muscle ◽  
Reduction Rate ◽  
Thyroid Eye Disease ◽  
Eye Disease ◽  
Decompression Surgery ◽  
Orbital Decompression ◽  
Element Analysis ◽  
Orbital Wall

Abstract Background To evaluate the risk of general orbital decompression in patients with thyroid eye disease (TED).Methods In this study, we replicated the behavior of intraorbital tissue in patients with TED based on finite element analysis. The orbit and intraorbital tissues of TED patient who underwent orbital decompression were modeled as finite element models. The stress was examined at a specific location of the removed orbital wall of a patient with TED who had undergone orbital decompression, and its variation was investigated and analyzed as a function of the shape and dimension (to be removed).Results In orbital decompression surgery which removes the orbital wall in a rectangular shape, the stress at the orbital wall decreased as the width and depth of the removed orbital wall increased. In addition, the stress of the non-chamfered model (a form of general orbital decompression) was higher than that of the chamfered model. Especially, in the case of orbital decompression, it can be seen that the chamfered model compared to the non-chamfered model have the stress reduction rate from 11.08% to 97.88%.Conclusions It is inferred that if orbital decompression surgery considering the chamfered model is performed on an actual TED patient, it is expected that the damage to the extraocular muscle caused by the removed orbital wall will be reduced.

Extraocular Muscle Volumetry for Assessment of Thyroid Eye Disease

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Georgios Bontzos ◽  
Efrosini Papadaki ◽  
Michael Mazonakis ◽  
Thomas G. Maris ◽  
Nikolaos G. Tsakalis ◽  
...  
Keyword(s):  
Extraocular Muscle ◽  
Thyroid Eye Disease ◽  
Eye Disease

Prognostic Factors of Restrictive Myopathy in Thyroid Eye Disease

2021 ◽  
Author(s):  
Jae Hwan Choi ◽  
Hoon Noh ◽  
Yoon-Duck Kim ◽  
Kyung In Woo
Keyword(s):  
Prognostic Factors ◽  
Ct Scan ◽  
Extraocular Muscle ◽  
Smoking Status ◽  
Thyroid Eye Disease ◽  
Eye Disease ◽  
Clinical Activity ◽  
Thyroid Autoantibody ◽  
Initial Concentration

Abstract To investigate the prognostic factors of extraocular muscle restriction in patients with thyroid eye disease (TED), sixty-five patients with TED and restrictive myopathy were evaluated. Demographics, clinical activity score (CAS), smoking status, thyroid disease status, thyroid hormone status, thyroid autoantibody status, orbital computed tomography (CT) scan at initial presentation, and treatment regimens were assessed. The movements of the most severely affected extraocular muscles were categorized into five grades. The patients were divided into the improved and the not-improved group based on the improvement in the limitation of the extraocular muscle excursion (LOM) throughout the follow-up, and the groups were compared using clinical factors. The mean LOM significantly improved from 2.3 ± 1.1 to 1.7 ± 1.2 after 1 year of follow-up. The excursion of the most restricted muscle improved in 32 patients but not in 33 patients during the follow-up. The initial concentration of the thyroid-stimulating antibody (TSAb) was significantly lower in the improved than in the not-improved group. Age, sex, smoking status, CAS, thyroid status, and muscle thickness on the CT scan did not significantly differ in the groups. This study showed that the initial concentration of TSAb is a factor affecting the recovery of restrictive myopathy.

scholarly journals Geometric and Volumetric Measurements of Orbital Structures in CT Scans in Thyroid Eye Disease Classification

2021 ◽  
Vol 11 (11) ◽  
pp. 4873
Author(s):  
Yuekun Bao ◽  
Zhihui Zhang ◽  
Cheng Li ◽  
Huan Ma ◽  
Pan Yin ◽  
...  
Keyword(s):  
Extraocular Muscle ◽  
Soft Tissues ◽  
Population Distribution ◽  
Ct Images ◽  
Thyroid Eye Disease ◽  
Ct Scans ◽  
Eye Disease ◽  
Orbital Apex ◽  
The Mean ◽  
Volumetric Measurements

This study examines the usefulness of both geometric and volumetric measurements of orbital soft tissues on CT scans to provide quantitative diagnostic guidance in image reading of thyroid eye disease (TED). Computed tomography (CT) images were obtained from 92 orbits and were classified as impaired motility (TED-IM) and normal motility (TED-NM). The TED-IM group was further divided into dysthyroid optic neuropathy (DON) and non-DON groups. There were 5 volumetric, 2 angular, and 3 ratio parameter measurements acquired from CT images to examine their feasibility in TED classification. We found that the mean volumes of extraocular muscle and retroorbital fat and their ratio to the orbital volume were significantly different between the two motility groups. The mean ratio of extraocular muscle volume in orbital apex and orbital apex volume (EMV-OA/OAV) was significantly larger in DON than non-DON patients (p < 0.05). The population distribution among TED-NM, non-DON, and DON groups significantly varied for different angles between the optic nerve and medial rectus and lateral rectus. In conclusion, geometric and volumetric measurements using CT scans help to quantitatively classify TED.

Sign in / Sign up

Export Citation Format

Share Document