Correlation between Extraocular Muscle Size Measured by Computed Tomography and the Vertical Angle of Deviation in Thyroid Eye Disease

Abstract Background Postoperative ocular imbalance is an important problem for orbital decompression surgery in thyroid eye disease (TED). The aim of this study was to evaluate the changes in unilateral ocular deviation and duction following orbital decompression and discuss the biomechanics of ocular imbalance. Methods Fifty-four TED patients who underwent unilateral orbital decompression were included. Fifteen patients underwent 1-wall (deep lateral wall) decompression, 18 patients underwent 2-wall (deep lateral and medial wall) decompression and 21 patients underwent 3-wall (deep lateral, medial and inferior wall) decompression. Objective and subjective deviation of the operated eyes were evaluated using the prism test and synoptophore, respectively. Ocular ductions were measured using Hirschberg’s method. The diameters of the extraocular rectus were measured by computed tomography. Results Ocular deviation and duction showed no significant difference after 1-wall decompression (p = 0.25–0.89). Esotropia increased after 2-wall decompression (p = 0.001–0.02), and hypotropia increased after 3-wall decompression (p = 0.02). Adduction increased but abduction decreased following 2-wall and 3-wall decompression (p < 0.05). Infraduction increased following 3-wall decompression (p < 0.001). Additionally, the increase in esotropia was significantly correlated with the increase in adduction and with the decrease in abduction (r = 0.37–0.63, p < 0.05). There were significant correlations between the diameter of the medial rectus and the increase in esotropia, the increase in adduction and the decrease in abduction postoperatively (r = 0.35–0.48, p < 0.05). Conclusions The changes in ocular deviation and duction were different after 1-wall, 2-wall and 3-wall orbital decompression. The increased contractile force of the rectus may be an important reason for strabismus changes after orbital decompression surgery.

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Extraocular Muscle Enlargement and Thyroid Eye Disease-like Orbital Inflammation Associated with Immune Checkpoint Inhibitor Therapy in Cancer Patients

Ophthalmic Plastic and Reconstructive Surgery ◽

10.1097/iop.0000000000001161 ◽

2019 ◽

Vol 35 (1) ◽

pp. 50-52 ◽

Cited By ~ 8

Author(s):

Oded Sagiv ◽

Thomas J. Kandl ◽

Sudip D. Thakar ◽

Bradley A. Thuro ◽

Naifa L. Busaidy ◽

...

Keyword(s):

Cancer Patients ◽

Immune Checkpoint ◽

Extraocular Muscle ◽

Immune Checkpoint Inhibitor ◽

Checkpoint Inhibitor ◽

Inhibitor Therapy ◽

Thyroid Eye Disease ◽

Eye Disease ◽

Orbital Inflammation ◽

Checkpoint Inhibitor Therapy

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Extraocular muscle problems in thyroid eye disease

Eye ◽

10.1038/eye.1994.125 ◽

1994 ◽

Vol 8 (5) ◽

pp. 497-505 ◽

Cited By ~ 32

Author(s):

Peter Fells ◽

Linda Kousoulides ◽

Anastasia Pappa ◽

Peter Munro ◽

Joanna Lawson

Keyword(s):

Extraocular Muscle ◽

Thyroid Eye Disease ◽

Eye Disease

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A Case of Thyroid Eye Disease Revealed During Secondary Adrenal Insufficiency

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1858 ◽

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.

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Jod-Basedow phenomenon: Reactivation of thyroid eye disease after contrast computed tomography

African Vision and Eye Health ◽

10.4102/aveh.v77i1.436 ◽

2018 ◽

Vol 77 (1) ◽

Author(s):

Roland Hollhumer ◽

Francesca Indiveri

Keyword(s):

Computed Tomography ◽

Optic Nerve ◽

Rare Condition ◽

Thyroid Eye Disease ◽

Eye Disease ◽

Clinical Activity ◽

Clinical Activity Score ◽

Nerve Dysfunction ◽

Intravenous Steroids ◽

Contrast Ct

To report a case of Jod-Basedow phenomenon, where a patient with quiescent thyroid eye disease became active after a contrast computed tomography (CT). A patient with clinically inactive thyroid eye disease underwent a contrast CT, after which her clinical activity score increased for 1 to 6/10 with optic nerve dysfunction. She was managed medically with intravenous steroids, neomercazole and propranolol. Jod-Basedow phenomenon is a rare condition where thyroid eye disease reactivates after a large iodine bolus. It is important for clinicians to be aware of this when considering special investigations, such as contrast scans, where iodine is given in large doses.

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

10.21203/rs.3.rs-1151937/v1 ◽

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.

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Extraocular Muscle Volumetry for Assessment of Thyroid Eye Disease

Journal of Neuro-Ophthalmology ◽

10.1097/wno.0000000000001339 ◽

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

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Prognostic Factors of Restrictive Myopathy in Thyroid Eye Disease

10.21203/rs.3.rs-155895/v1 ◽

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.

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