Occurrence of Graves' Orbitopathy and Graves' Hyperthyroidism after a Trauma to the Eye

The selection of target areas for orbital imaging, application of diethylenetriaminepentaacetic acid orbital imaging, clinical factors, alkaline phosphatase, and thyrotropin receptor antibodies in the staging and grading of thyroid-associated ophthalmopathy

PURPOSE

This study aimed to investigate the active phase of thyroid-associated ophthalmopathy (TAO), its correlations with clinical factors, serological tests, and orbital imaging parameters, and evaluate the diagnostic value of different orbital imaging target areas.

METHODS

A total of 45 patients with thyroid-related eye disease underwent imaging, serological tests, and clinical data collection. Clinical Activity Score (CAS) assessment, diplopia scores, and NOSPECS grading were conducted. Radioactive counts of extraocular muscles and tear glands were measured. Computed tomography scans assessed exophthalmos and extraocular muscle thickening. Correlations and differences among study parameters and grades were evaluated using receiver operating characteristic curves.

RESULTS

Active TAO correlated significantly with radioactive counts of muscles and tear glands, alkaline phosphatase (ALP), thyrotropin receptor antibody (TRAb), and age. Significant differences were found among NOSPECS grades for studied variables (except ALP and TRAb). Extraocular muscle thickening was confirmed as a reliable diagnostic criterion. High consistency was found between orbital imaging and CAS staging. Treatment showed varying degrees of improvement in active patients, while nonactive patients showed no progression during follow-up. Receiver operating characteristic curves demonstrated high diagnostic efficacy for tear gland radioactive counts.

CONCLUSION

Tear glands and extraocular muscles have high diagnostic value in TAO, with tear glands showing a higher value. Orbital imaging provides an objective and comprehensive assessment compared with CAS scoring alone. ALP, TRAb, and age also play significant roles in staging.

Graves' disease

Graves' disease (GD) is an autoimmune disease that primarily affects the thyroid gland. It is the most common cause of hyperthyroidism and occurs at all ages but especially in women of reproductive age. Graves' hyperthyroidism is caused by autoantibodies to the thyroid-stimulating hormone receptor (TSHR) that act as agonists and induce excessive thyroid hormone secretion, releasing the thyroid gland from pituitary control. TSHR autoantibodies also underlie Graves' orbitopathy (GO) and pretibial myxoedema. Additionally, the pathophysiology of GO (and likely pretibial myxoedema) involves the synergism of insulin-like growth factor 1 receptor (IGF1R) with TSHR autoantibodies, causing retro-orbital tissue expansion and inflammation. Although the aetiology of GD remains unknown, evidence indicates a strong genetic component combined with random potential environmental insults in an immunologically susceptible individual. The treatment of GD has not changed substantially for many years and remains a choice between antithyroid drugs, radioiodine or surgery. However, antithyroid drug use can cause drug-induced embryopathy in pregnancy, radioiodine therapy can exacerbate GO and surgery can result in hypoparathyroidism or laryngeal nerve damage. Therefore, future studies should focus on improved drug management, and a number of important advances are on the horizon.