Skip to main content
SpringerLink
Log in

Imaging in Graves’ Ophthalmopathy

  • Chapter
Thyroid Eye Disease

Part of the book series: Endocrine Updates ((ENDO,volume 14))

  • 151 Accesses

Abstract

Graves’ ophthalmopathy (GO) is an autoimmune condition of the orbit which is closely associated with Graves’ hyperthyroidism, though either condition may exist without the other. It may antedate, coincide with or follow hyperthyroidism (1–5). Assessment of the frequency of the association depends on the method used for detecting GO; with sensitive methods sub clinical GO can be demonstrated in 60–70% of patients with hyperthyroidism, whereas it is clinically apparent and moderately severe in about 10%. The clinical features of the disorder vary from a mild grittiness of the eyes to severe diplopia, loss of vision and disfiguring proptosis. The pathogenesis is poorly understood, and the available methods for prevention and treatment are far from ideal. The most obvious pathological change within the orbit is the enlargement of extra ocular muscles (6). In most cases microscopy reveals that the muscle fibers are preserved and the increase in muscle bulk reflects changes in the connective tissue: fibroblasts are very numerous, there is lymphocyte infiltration (8–12), an excessive deposition of collagen and of glycosaminoglycans (GAG) which lead to interstitial edema. A role for cytokines in GO (13) seems likely: it may be that the autoimmune response evokes the local production within the orbit of cytokines which cause fibroblast stimulation and hence the production of collagen and GAGs (14–18). The muscles most frequently affected are the medial and inferior recti. Functionally the effect is of tightness or contraction of the muscles, and thus the patient may experience difficulty with upward or lateral gaze.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bahn RS, Garrity JA, Gorman CA. Diagnosis and management of Graves’ophthalmopathy. J Clin Endocrinol Metab 1990; 71: 559–563.

    Article  PubMed  CAS  Google Scholar 

  2. Riley FC. Orbital pathology in Graves’disease. Mayo Clin Proc 1972; 47: 975–979.

    Google Scholar 

  3. Bartley GB, Gorman CA. Diagnostic criteria for Graves’ophthalmopathy. Am J Ophthalmol 1996; 119: 792–795.

    Google Scholar 

  4. Kahaly G (Ed). Endocrine Ophthalmopathy. Molecular, immunological and clinical aspects. Karger publishers, Basel, 1993.

    Google Scholar 

  5. Kahaly GJ, Böckmann, Beyer J, Bischoff S. Longterm observation of endocrine ophthalmopathy and retrospective appraisal of therapeutic measures. J Endocrinol Invest 1990; 13: 287–293.

    PubMed  CAS  Google Scholar 

  6. Char DH. Thyroid eye disease. Butterworth-Heinemann publishers, Boston, 1999, 3rdedition.

    Google Scholar 

  7. Kahaly G, Hansen C, Felke B, Dienes HP. Immunohistochemical staining of retro-bulbar adipose tissue in Graves’ ophthalmopathy. Clin Immunol Immunopathol 1994; 73: 53–62

    Article  PubMed  CAS  Google Scholar 

  8. Otto E, Ochs K, Leyendecker E, Gentsch A, Kahaly GJ. Autoimmune endocrine ophthalmopathy and retrobulbar antigens. Horm Metab Res 1995; 27: 533–538.

    Article  PubMed  CAS  Google Scholar 

  9. Otto E, Förster G, Kuhlemann, Hansen C, Kahaly GJ. TSH receptor in endocrine autoimmunity. Clin Exp Rheumatol 1996; 14: 77–84.

    Google Scholar 

  10. Otto EA, Ochs K, Hansen C, Wall JR, Kahaly GJ. Orbital tissue-derived T lymphocytes from patients with Graves’ophthalmopathy recognize autologous orbital antigens. J Clin Endocrinol Metab 1996; 81: 3045–3050.

    Article  PubMed  CAS  Google Scholar 

  11. Kahaly GJ, Otto E, Förster G, et al. T cells and orbital connective tissue in endocrine orbitopathy. Exp Clin Endocrinol Diabetes 1996; 104: 79–83.

    Article  PubMed  CAS  Google Scholar 

  12. Förster G, Otto E, Hansen C, Ochs K, Kahaly GJ. Analysis of orbital T cells in thyroid-associated ophthalmopathy. Clin Exp immunol 1998; 112: 427–434.

    Article  PubMed  Google Scholar 

  13. Natt N, Bahn RS. Cytokines in the evolution of Graves’ophthalmopathy. Autoimmunity 1997; 26: 129–136.

    Article  PubMed  CAS  Google Scholar 

  14. Kahaly G, Schuler M, Sewell AC, Bernard G, Beyer J & Krause U. Urinary glycosaminoglycans in Graves’ ophthalmopathy. Clin Endocrinol 1990; 33: 35–44

    Article  CAS  Google Scholar 

  15. Hansen C, Otto E, Kuhlemann K, Förster G, Kahaly GJ. Glycosaminoglycans in autoimmunity. Clin Exp Rheumatol 1996; 14: 59–68.

    Google Scholar 

  16. Hansen C, Fraiture B, Rouhi R, Otto E, Förster G, Kahaly GJ. HPLC glycosaminoglycan analysis in patients with Graves’disease. Clin Sci 1997; 92: 511–517.

    PubMed  CAS  Google Scholar 

  17. Kahaly GJ, Forster G, Hansen C. Glycosaminoglycans in thyroid eye disease. Thyroid 1998; 8: 429–432.

    Article  PubMed  CAS  Google Scholar 

  18. Hansen C, Rouhi R, Förster G, Kahaly GJ. Increased sulfatation of orbital glycosaminoglycans in Graves’ophthalmopathy. J Clin Endocrinol Metab 1999; 84: 14091413.

    Google Scholar 

  19. Hales IB & Rundle FF. Ocular changes in Graves’ disease. A long-term follow-up study. Quart J Med 1960; 29: 113–126

    PubMed  CAS  Google Scholar 

  20. Kahaly GJ, Schrezenmeir J, Krause U, et al. Ciclosporin and prednisone vs prednisone in treatment of Graves’ ophthalmopathy: a controlled, randomized and prospective study. Eur J Clin Invest 1986; 16: 415–422.

    Article  PubMed  CAS  Google Scholar 

  21. Kahaly GJ, Pitz S, Müller-Forell W, Hommel G. Randomized trial of intravenous immunoglobulins vs prednisolone in Graves’ophthalmopathy. Clin Exp Immunol 1996; 106: 197–202.

    Article  PubMed  CAS  Google Scholar 

  22. Kahaly GJ, Roesler HP, Kutzner J, et al. Radiotherapy for thyroid-associated orbitopathy. Exp Clin Endocrinol Diabetes 1999; 107: 201–207.

    Article  Google Scholar 

  23. Kahaly GJ, Roesler HP, Pitz S, Hommel G. Low vs high-dose radiotherapy for Graves’ ophthalmopathy: A randomized, single-blind trial. J Clin Endocrinol Metab 2000; 85: 102–108.

    Article  PubMed  CAS  Google Scholar 

  24. Kahaly GJ, Gorman CA, Kal KB, et al. Radiotherapy for Graves’ ophthalmopathy. In Prummel MF (ed): recent developments in Graves’ ophthalmopathy. Kluwer publishers 2000, pp 115–131.

    Chapter  Google Scholar 

  25. Mann WJ, Kahaly GJ, Lieb W, Amedee RG. Orbital decompression for endocrine ophthalmopathy: the endonasal approach. Am J Rhinol 1994; 8: 123–7.

    Article  Google Scholar 

  26. Mann WJ, Kahaly GJ, Pitz S, et al. Decompression surgery for thyroid-associated orbitopathy - A ten year experience. Exp Clin Endocrinol Diabetes 1999; 107: 212213.

    Google Scholar 

  27. Flanders AE, Mafee MF, Rao VM, Choi KH. CT characteristics of orbital pseudotumor and other orbital inflammatory processes. J Comput Assist Tomogr 1989; 13: 40–47.

    Article  PubMed  CAS  Google Scholar 

  28. Flanders AE, Mafee MF, Rao VM, Choi KH. CT characteristics of orbital pseudotumor and other orbital inflammatory processes. J Comput Assist Tomogr 1989; 13: 40–47.

    Article  PubMed  CAS  Google Scholar 

  29. Weetman AP, Wiersinga WM. Current management of thyroid-associated ophthalmopathy in Europe. Results of an international survey. Clin Endocrinol 1998; 49: 2128.

    Article  CAS  Google Scholar 

  30. Kahaly GJ. New imaging procedures in thyroid-associated ophthalmopathy. Orbit 1996; 15: 165–175.

    Article  Google Scholar 

  31. Müller-Forell W, Pitz S, Mann W, Kahaly GJ. Neuroradiological diagnosis of thyroid-associated orbitopathy. Exp Clin Endocrinol Diabetes 1999; 107: 177–183.

    Article  Google Scholar 

  32. Gorman CA. The measurement of change in Graves’ophthalmopathy. Thyroid 1998; 8: 539–543.

    Article  PubMed  CAS  Google Scholar 

  33. Trokel L, Jacobiec FA. Correlation of CT scanning and pathologic features of opthalmic Graves’disease. Ophthalmology 1981; 88: 553–564.

    PubMed  CAS  Google Scholar 

  34. Neigel JM, Rootman J, Belkin RI, et al. Dysthyroid optic neuropathy. Ophthalmology 1988; 95: 1515–1521.

    PubMed  CAS  Google Scholar 

  35. Nugent RA, Belkin RI, Neigel JM, et al. Graves’ orbitopathy: correlation of CT and clinical findings. Radiology 1990; 177: 675–682.

    PubMed  CAS  Google Scholar 

  36. Forbes G, Gorman CA, Gehring D, Baker HL Jr. Computer analysis of orbital fat and muscle volumes in Graves’ophthalmopathy. Am J Neuroradiol 1983; 4: 737–742.

    PubMed  CAS  Google Scholar 

  37. Forbes G, Gehring DG, Gorman CA, Brennan MD, Jackson IT. Volume measurements of normal orbital structures by computed tomographic analysis. Am J Neuroradiol 1985; 6: 419–424.

    Google Scholar 

  38. Forbes G, Gorman CA, Brennan MD, et al. Ophthalmopathy of Graves’disease: Computerized volume measurements of orbital fat and muscle. Am J Neuroradiol 1986; 7: 651–656.

    PubMed  CAS  Google Scholar 

  39. Enzmann DR, Donaldson SS, Kriss JP. Appearance of Graves’disease on orbital computed tomography. J Comput Assist Tomogr 1979; 3: 815–819.

    PubMed  CAS  Google Scholar 

  40. Yoshikawa K, Higashide T, Nakase Y, et al. Role of rectus muscle enlargement in clinical profile of dysthyroid ophthalmopathy. Jpn J Ophthalmol 1991; 35: 175–181.

    PubMed  CAS  Google Scholar 

  41. Barret L, Glatt HJ, Burde RM, Gado MH. Optic nerve dysfunction in thyroid eye disease: CT. Radiology 1988; 167: 503–508.

    Google Scholar 

  42. Feldon SE, Celina P, Saudra K, et al. Quantitative computer tomography of Graves’ophthalmopathy. Arch Ophthalmol 1985; 103: 213–215.

    Article  PubMed  CAS  Google Scholar 

  43. Hallin ES & Feldon SE. Graves’ ophthalmopathy: II. Correlation of clinical signs with measures derived from computed tomography. Br J Ophthalmol 1988; 72: 678682

    Google Scholar 

  44. Hosten N, Sander B, Cordes M, et al. Graves’ ophthalmopathy: MR imaging of the orbits. Radiology 1989; 172: 759–762

    PubMed  CAS  Google Scholar 

  45. Just M, Kahaly GJ, Higer HP, et al. Graves’ ophthalmopathy: role of MR imaging in radiation therapy. Radiology 1991; 179: 187–190.

    PubMed  CAS  Google Scholar 

  46. Hiromatsu Y, Kojima K, Ishisaka N, et al. Role of magnetic resonance imaging in thyroid-associated ophthalmopathy: Its predictive value for therapeutic outcome of immunosuppressive therapy. Thyroid 1992; 2: 299–305.

    Article  PubMed  CAS  Google Scholar 

  47. Pauleit D, Schuller H, Textor J, et al. MR relaxation time measurements with and without selective fat suppression (SPIR) in endocrine orbitopathy. Röfö 1997; 176: 557–564.

    Google Scholar 

  48. Nianiaris N, Hurwitz JJ, Chen JC, Wortzman G. Correlation between computed tomography and magnetic resonance imaging in Graves’orbitopathy. Can J Opthalmol 1994; 29: 9–12.

    CAS  Google Scholar 

  49. Nishikawa M, Yoshimura M, Toyoda N, et al. Correlation of orbital muscle changes evaluated by magnetic resonance imaging and thyroid stimulating antibody in patients with Graves’ophthalmopathy. Endocrinol 1993; 129: 213–219.

    CAS  Google Scholar 

  50. Ohnishi T, Noguchi S, Murakami N, et al. Extraocular Muscles in Graves’ opthalmopathy: Usefulness of T2 relaxation time measurements. Radiology 1994; 190: 857–862.

    PubMed  CAS  Google Scholar 

  51. Utech CI, Khatibnia U, Winter Pf, Wulle KG. MR T2 relaxation time for the assessment of retrobulbar inflammation in Graves’ ophthalmopathy. Thyroid 1995; 5: 185193.

    PubMed  CAS  Google Scholar 

  52. Kahaly G, Diaz M, Just M, Beyer J & Lieb N. Role of octreoscan and correlation with MR imaging in Graves’ ophthalmopathy. Thyroid 1995; 5:107–111

    Article  PubMed  CAS  Google Scholar 

  53. Werner SC, Coleman DJ, Franzen LA. Ultrasonographic evidence of a consistano orbital involvement in Graves’ disease. N Engl J Med 1974; 290: 1447–1450.

    Article  PubMed  CAS  Google Scholar 

  54. Willinsky RA, Arenson AM, Hurwitz J, Szalai J. Ultrasonic B scan measurement of the extraocular muscles in Graves’orbitopathy. J Can Assoc Radiol 1984; 35: 171–173.

    PubMed  CAS  Google Scholar 

  55. Holt JE, O’connor PS, Douglas JP, Byrne B. Extraocular muscle size comparison using standardized A-scan echography and computed tomography scan measurements. Ophthalmology 1985; 92: 1351–1356.

    PubMed  CAS  Google Scholar 

  56. Delint PJ, Mounts MP, Kerlen CH, et al. B-scan ultrasonography in Graves’orbitopathy. Documenta Ophthalmol 1993; 85: 1–4.

    Article  CAS  Google Scholar 

  57. Byrne FS, Gendron E, Glaser J, et al. Diameter of normal extraocular muscles with echography. Am J Ophthalmol 1991; 112: 706–712.

    PubMed  CAS  Google Scholar 

  58. Erickson BA, Harris GJ, Lewandowski MF, Murray KJ, & Massaro BM. Echo-graphic monitoring of response of extraocular muscles to irradiation in Graves’ ophthalmopathy. Int J Radiat Oncol Biol Phys 1995; 31: 651–660

    Article  PubMed  CAS  Google Scholar 

  59. Prummel MF, Suttorp-Schulten MSA, Wiersinga WM, et al. A new ultrasonographic method to detect disease activity and predict response to immunosuppressive treatment in Graves’ ophthalmopathy. Ophthalmology 1993; 100: 556–561.

    PubMed  CAS  Google Scholar 

  60. Prummel MF (ed): recent developments in Graves’ ophthalmopathy. Kluwer publishers 2000.

    Google Scholar 

  61. Given-Wilson R, Pope RM, Michell MJ, Cannon R & McGregor AM. The use of real/time orbital ultrasound in Graves’ ophthalmopathy: a comparison with computer tomography. Br J Radiol 1989; 62: 705–709

    Article  PubMed  CAS  Google Scholar 

  62. Demer JL, Kerman BM. Comparison of standardized echography with magnetic resonance imaging to measure extraocular muscle size. Am J Ophthalmol 1994; 118: 351–361.

    PubMed  CAS  Google Scholar 

  63. Nagy EV, Toth J, Kaldi I, et al. Graves’ophthalmopathy: eye muscle involvement in patients with diplopia. Eur J Endocrinol 2000; 142: 591–597.

    Article  PubMed  CAS  Google Scholar 

  64. Benning H, Lieb W, Kahaly GJ, Grehn F. Color Doppler ultrasound findings in patients with thyroid ophthalmopathy. Ophthalmologe 1994; 91: 20–25.

    PubMed  CAS  Google Scholar 

  65. Krenning EP, Bakker, WH, Kooij PPM,et al.: Somatostatin receptor scintigraphy with (111-In-DTPA-D-Phel)-octreotide in man: metabolism, dosimetry, and comparison with 123-I-Tyr-3)-octreotide. J Nucl Med 1992; 33: 652–658.

    PubMed  CAS  Google Scholar 

  66. Krenning EP, Kwekkeboom DJ, Bakker WH, et al. Somatostatin receptor scintigraphy with (III-In-DTAP-D-Phe l) and (123 I-Tyra) - octreotide: the Rotterdam experience with more than 1000 patients. Eur J Nucl Med 1993; 20: 716–731.

    Article  PubMed  CAS  Google Scholar 

  67. Krassas GE, Kahaly GJ. The role of octreoscan in thyroid eye disease. Eur J Endocrinol 1999; 140: 373–375.

    Article  PubMed  CAS  Google Scholar 

  68. Wiersinga WM, Gerding MN, Prummel MF & Krenning EP. Octreotide scintigraphy in thyroidal and orbital Graves’ disease. Thyroid 1998; 8: 433–436

    Article  PubMed  CAS  Google Scholar 

  69. Durak I, Durak H, Ergin M, Yurekli Y & Kaynak S. Somatostatin receptors in the orbit. Clin Nucl Med 1995; 20: 237–242

    Article  PubMed  CAS  Google Scholar 

  70. Bohuslavizki KH, Oberwohrmann S, Brenner W, & al. 1l 1 -In-Octreotide imaging in patients with longstanding Graves’ ophthalmopathy. Nucl Med Commun 1995; 16: 912–916

    Article  PubMed  CAS  Google Scholar 

  71. Krassas GE, Dumas A & Moncayo R. Octreoscan in Graves’ ophthalmopathy (letter). Thyroid. 1997; 7: 805–806

    Article  PubMed  CAS  Google Scholar 

  72. Förster GJ, Krummenauer F, Nickel O, & Kahaly GJ. Somatostatin-receptor scintigraphy in Graves’disease: Reproducibility and inter-/intra-observer variability. Cancer Biotherap Radiol (in press)

    Google Scholar 

  73. Förster GJ, Nickel O, Raab D, Andreas J, Kahaly GJ. Somatostatin-receptor scintigraphy in Graves’ophthalmopathy. A new, standardized method for assessement of orbital disease activity. J Nucl Med 1999; 40: 207 abstract

    Google Scholar 

  74. Kahaly G, Diaz M, Hahn K, Beyer J & Bockisch A. Indium 1 l 1- Pentetreotide scintigraphy in Graves’ ophthalmopathy. J Nucl Med 1995; 36: 550–554

    PubMed  CAS  Google Scholar 

  75. Kahaly G, Görges R, Diaz M, Hommel G & Bockisch A. Indium-Ill- Pentetreotide in Graves’ Disease. J Nucl Med 1998; 39: 533–536

    PubMed  CAS  Google Scholar 

  76. Kahaly GJ, Förster GJ. Somatostatin receptor scintigraphy in thyroid eye disease. Thyroid 1998; 8: 549–552.

    Article  PubMed  CAS  Google Scholar 

  77. Postema PTE, Krenning EP, Wijngaarde R, et al. (111-In-DTPA-D-Phel) octreotide scintigraphy in thyroidal and orbital Graves’ disease: A parameter for disease activity? J Clin Endocrinol Metab 1994; 79: 1845–1851.

    Article  PubMed  CAS  Google Scholar 

  78. Moncayo R, Baldnisera I, Decristoforo C, Kendler D, & Donnemiller E. Evaluation of immunological mechanisms mediating thyroid - associated ophthalmopathy by radionuclide imaging using somatostatin analog 111-In-octreotide. Thyroid 1997; 7: 21–29

    Article  PubMed  CAS  Google Scholar 

  79. Krassas GE, Dumas A, Pontikides N & Kaltsas Th. Somatostatin receptor scintigraphy and octreotide treatment in patients with thyroid eye disease. Clin Endocrinol 1995; 42: 571–580

    Article  CAS  Google Scholar 

  80. Krassas GE, Dumas A, Kaltsas Th, Halkias A, Pontikides N. Somatostatin receptor scintigraphy before and after treatment with somatostin analogues in patients with thyroid eye disease. Thyroid 1999; 9: 47–52.

    Article  PubMed  CAS  Google Scholar 

  81. Gerding MN, van der Zant FM, van Royen EA, et al. Octreotide-scintigraphy is a disease-activity parameter in Graves’ophthalmopathy. Clin Endocrinol 1999; 50: 373–379.

    Article  CAS  Google Scholar 

  82. Krassas GE, Kaltsas Th, Dumas A, Pontikides N & Tolis G. Lanreotide in the treatment of patients with thyroid eye disease. Eur J Endocrinol 1999; 136: 416–422

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Endocrinology/Metabolism, Gutenberg - University Hospital, Mainz, Germany

    George J. Kahaly

  2. Neuroradiology, Gutenberg - University Hospital, Mainz, Germany

    Wibke Müller-Forell

  3. Nuclear Medicine, Gutenberg - University Hospital, Mainz, Germany

    Gregor J. Förster

  4. Ophthalmology, Gutenberg - University Hospital, Mainz, Germany

    Susanne Pitz

  5. Therapeutic Radiology, Gutenberg - University Hospital, Mainz, Germany

    Hans Peter Rösier

  6. ENT, Gutenberg - University Hospital, Mainz, Germany

    Wolf J. Mann

Authors
  1. George J. Kahaly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wibke Müller-Forell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gregor J. Förster
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susanne Pitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hans Peter Rösier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wolf J. Mann
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Division of Endocrinology, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA

    Rebecca S. Bahn

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer Science+Business Media New York

About this chapter

Cite this chapter

Kahaly, G.J., Müller-Forell, W., Förster, G.J., Pitz, S., Rösier, H.P., Mann, W.J. (2001). Imaging in Graves’ Ophthalmopathy. In: Bahn, R.S. (eds) Thyroid Eye Disease. Endocrine Updates, vol 14. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-1447-3_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-1447-3_9

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-5558-8

  • Online ISBN: 978-1-4615-1447-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation