eMedicine Specialties > Radiology > Head/Neck

Ophthalmopathy, Thyroid: Multimedia

Author: Michael T Yen, MD, Associate Professor of Ophthalmology, Department of Ophthalmology, Division of Ophthalmic Plastic, Lacrimal, and Orbital Surgery, Cullen Eye Institute, Baylor College of Medicine
Coauthor(s): Rudolph Lin, MD, Chief of Radiology, Department of Radiology, St. Elizabeth Hospital; Kimberly G Yen, MD, Assistant Professor of Ophthalmology, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine
Contributor Information and Disclosures

Updated: Mar 18, 2009

Multimedia

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Media file 1: Severe proptosis and eyelid retraction from thyroid-related orbitopathy. This patient also had optic nerve dysfunction from thyroid related orbitopathy.

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Severe proptosis and eyelid retraction from thyroid-related orbitopathy. This patient also had optic nerve dysfunction from thyroid related orbitopathy.

(Enlarge Image)

Media file 2: Although this patient had mild proptosis, there was also prominent eyelid retraction with temporal flare on the left.

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Although this patient had mild proptosis, there was also prominent eyelid retraction with temporal flare on the left.

(Enlarge Image)

Media file 3: Computed tomography axial image demonstrates the enlarged bellies of the extraocular muscle without involvement of the tendinous insertion to the globe.

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Computed tomography axial image demonstrates the enlarged bellies of the extraocular muscle without involvement of the tendinous insertion to the globe.

(Enlarge Image)

Media file 4: Computed tomography coronal section through the orbit demonstrates enlargement of multiple muscles within the orbit.

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Computed tomography coronal section through the orbit demonstrates enlargement of multiple muscles within the orbit.

(Enlarge Image)

Media file 5: Prominent intraconal fat can also result in proptosis and straightening of the optic nerve. In addition, this patient has mild enlargement of the extraocular muscles.

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Prominent intraconal fat can also result in proptosis and straightening of the optic nerve. In addition, this patient has mild enlargement of the extraocular muscles.

(Enlarge Image)

Media file 6: Computed tomography axial section of the orbit. Note the enlargement of the muscle bellies that spare the tendinous insertion on the globe.

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Computed tomography axial section of the orbit. Note the enlargement of the muscle bellies that spare the tendinous insertion on the globe.

(Enlarge Image)

Media file 7: Computed tomography axial section demonstrates enlarged inferior rectus muscles.

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Computed tomography axial section demonstrates enlarged inferior rectus muscles.

(Enlarge Image)

Media file 8: Computed tomography coronal section of the same patient as in Image 7. The extraocular muscle bellies, especially the inferior rectus muscle on the right, are enlarged.

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Computed tomography coronal section of the same patient as in Image 7. The extraocular muscle bellies, especially the inferior rectus muscle on the right, are enlarged.

(Enlarge Image)

Media file 9: Computed tomography coronal section deeper in the orbit near the apex demonstrates crowding of the optic nerve by the enlarged extraocular muscles.

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Computed tomography coronal section deeper in the orbit near the apex demonstrates crowding of the optic nerve by the enlarged extraocular muscles.

(Enlarge Image)

Media file 10: B-scan ultrasonography reveals enlargement of the extraocular muscle belly. The tendinous insertion of the extraocular muscle at the globe is not thickened, which is characteristic of thyroid-related orbitopathy.

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B-scan ultrasonography reveals enlargement of the extraocular muscle belly. The tendinous insertion of the extraocular muscle at the globe is not thickened, which is characteristic of thyroid-related orbitopathy.

(Enlarge Image)

Media file 11: A-scan ultrasonography reveals medium to high internal reflectivity of the extraocular muscle belly.

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A-scan ultrasonography reveals medium to high internal reflectivity of the extraocular muscle belly.

More on Ophthalmopathy, Thyroid

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Multimedia: Ophthalmopathy, Thyroid

References

Kuriyan AE, Phipps RP, Feldon SE. The eye and thyroid disease. Curr Opin Ophthalmol. Nov 2008;19(6):499-506. [Medline].
Kim N, Hatton MP. The role of genetics in Graves' disease and thyroid orbitopathy. Semin Ophthalmol. Jan-Feb 2008;23(1):67-72. [Medline].
Khoo TK, Bahn RS. Pathogenesis of Graves' ophthalmopathy: the role of autoantibodies. Thyroid. Oct 2007;17(10):1013-8. [Medline].
Mayer EJ, Fox DL, Herdman G, et al. Signal intensity, clinical activity and cross-sectional areas on MRI scans in thyroid eye disease. Eur J Radiol. Oct 2005;56(1):20-4.
Taoka T, Sakamoto M, Nakagawa H, et al. Evaluation of extraocular muscles using dynamic contrast enhanced MRI in patients with chronic thyroid orbitopathy. J Comput Assist Tomogr. Jan-Feb 2005;29(1):115-20.
Dodds NI, Atcha AW, Birchall D, Jackson A. Use of high-resolution MRI of the optic nerve in Graves' ophthalmopathy. Br J Radiol. Jan 5 2009;[Medline].
Volpe NJ, Sbarbaro JA, Gendron Livingston K, et al. Occult thyroid eye disease in patients with unexplained ocular misalignment identified by standardized orbital echography. Am J Ophthalmol. Jul 2006;142(1):75-81.
Kuo PH, Monchamp T, Deol P. Imaging of inflammation in Graves'' ophthalmopathy by positron emission tomography/computed tomography. Thyroid. Apr 2006;16(4):419-20.
Stålberg P, Svensson A, Hessman O, Akerström G, Hellman P. Surgical treatment of Graves' disease: evidence-based approach. World J Surg. Jul 2008;32(7):1269-77. [Medline].
Alp MN, Ozgen A, Can I, et al. Colour Doppler imaging of the orbital vasculature in Graves'' disease with computed tomographic correlation. Br J Ophthalmol. Sep 2000;84(9):1027-30. [Medline].
Bartley GB, Fatourechi V, Kadrmas EF, et al. Clinical features of Graves'' ophthalmopathy in an incidence cohort. Am J Ophthalmol. Mar 1996;121(3):284-90. [Medline].
Bartley GB, Fatourechi V, Kadrmas EF, et al. Long-term follow-up of Graves ophthalmopathy in an incidence cohort. Ophthalmology. Jun 1996;103(6):958-62. [Medline].
Byrne SF, Gendron EK, Glaser JS, et al. Diameter of normal extraocular recti muscles with echography. Am J Ophthalmol. Dec 15 1991;112(6):706-13. [Medline].
Day RM, Carroll FD. Corticosteroids in the treatment of optic nerve involvement associated with thyroid dysfunction. Arch Ophthalmol. Mar 1968;79(3):279-82. [Medline].
Forrester JV, Sutherland GR, McDougall IR. Dysthyroid ophthalmopathy: orbital evaluation with B-scan ultrasonography. J Clin Endocrinol Metab. Aug 1977;45(2):221-4. [Medline].
Gerding MN, van der Zant FM, van Royen EA, et al. Octreotide-scintigraphy is a disease-activity parameter in Graves'' ophthalmopathy. Clin Endocrinol (Oxf). Mar 1999;50(3):373-9. [Medline].
Hall R, Kirkham K, Doniach D, el-Kabir D. Ophthalmic Graves'' disease. Diagnosis and pathogenesis. Lancet. Feb 21 1970;1(7643):375-8. [Medline].
Kahaly GJ. Imaging in thyroid-associated orbitopathy. Eur J Endocrinol. (Aug) 2001;145(2):107-18.
Nunery WR. Ophthalmic Grave's disease: a dual theory of pathogenesis. Ophthalmol Clin North Am. 1991;4:73-87.
Ozgen A, Alp MN, Ariyurek M, et al. Quantitative CT of the orbit in Graves'' disease. Br J Radiol. Aug 1999;72(860):757-62. [Medline].
Scott IU, Siatkowski MR. Thyroid eye disease. Semin Ophthalmol. Jun 1999;14(2):52-61. [Medline].
Shammas HJ, Minckler DS, Ogden C. Ultrasound in early thyroid orbitopathy. Arch Ophthalmol. Feb 1980;98(2):277-9. [Medline].
Trokel SL, Jakobiec FA. Correlation of CT scanning and pathologic features of ophthalmic Graves'' disease. Ophthalmology. Jun 1981;88(6):553-64. [Medline].
Weetman AP. Graves' disease. N Engl J Med. Oct 26 2000;343(17):1236-48. [Medline].

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Keywords

thyroid ophthalmopathy, thyroid eye disease, Graves disease, Graves' disease, Graves ophthalmopathy, thyrotoxic ophthalmopathy, thyrotoxic exophthalmos, thyroid-associated ophthalmopathy, endocrine exophthalmos

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Contributor Information and Disclosures

Author

Michael T Yen, MD, Associate Professor of Ophthalmology, Department of Ophthalmology, Division of Ophthalmic Plastic, Lacrimal, and Orbital Surgery, Cullen Eye Institute, Baylor College of Medicine
Michael T Yen, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, American Society of Ophthalmic Plastic and Reconstructive Surgery, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Rudolph Lin, MD, Chief of Radiology, Department of Radiology, St. Elizabeth Hospital
Rudolph Lin, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Kimberly G Yen, MD, Assistant Professor of Ophthalmology, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine
Kimberly G Yen, MD is a member of the following medical societies: Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

David S Levey, MD, PhD, Orthopedic/Spine MRI TeleRadiologist, Radsource, LLC
David S Levey, MD, PhD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

C Douglas Phillips, MD, Professor, Departments of Radiology, Neurosurgery, and Otolaryngology, University of Virginia Health Sciences Center
C Douglas Phillips, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Society of Head and Neck Radiology, American Society of Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

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eMedicine Specialties > Radiology > Head/Neck

Ophthalmopathy, Thyroid: Multimedia

Multimedia

Severe proptosis and eyelid retraction from thyroid-related orbitopathy. This patient also had optic nerve dysfunction from thyroid related orbitopathy.

Although this patient had mild proptosis, there was also prominent eyelid retraction with temporal flare on the left.

Computed tomography axial image demonstrates the enlarged bellies of the extraocular muscle without involvement of the tendinous insertion to the globe.

Computed tomography coronal section through the orbit demonstrates enlargement of multiple muscles within the orbit.

Prominent intraconal fat can also result in proptosis and straightening of the optic nerve. In addition, this patient has mild enlargement of the extraocular muscles.

Computed tomography axial section of the orbit. Note the enlargement of the muscle bellies that spare the tendinous insertion on the globe.

Computed tomography axial section demonstrates enlarged inferior rectus muscles.

Computed tomography coronal section of the same patient as in Image 7. The extraocular muscle bellies, especially the inferior rectus muscle on the right, are enlarged.

Computed tomography coronal section deeper in the orbit near the apex demonstrates crowding of the optic nerve by the enlarged extraocular muscles.

B-scan ultrasonography reveals enlargement of the extraocular muscle belly. The tendinous insertion of the extraocular muscle at the globe is not thickened, which is characteristic of thyroid-related orbitopathy.

A-scan ultrasonography reveals medium to high internal reflectivity of the extraocular muscle belly.

More on Ophthalmopathy, Thyroid

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor