A Comparison of Doppler Flow Parameters in the Ophthalmic Artery and Central Retinal Artery in Patients With Graves' Disease and Toxic Nodular Goiter.

Joanna Widłak,Grzegorz Kamiński,Dorota Walasik-Szemplińska,Iwona Sudoł-Szopińska,Małgorzata Mańczak

doi:10.3389/fendo.2019.00707

Abstract

Purpose: Despite unquestionable clinical usefulness of Clinical Activity Score, the evaluating system needs frequent supplementation. One of such diagnostic tools is Doppler imaging that is used for the analysis of flow in the retrobulbar vessels. The improvement of the reliability and sensibility of measurements could make Doppler imaging an everyday clinical tool and improve the efficacy of treatment in patients with active thyroid-associated orbitopathy. However, the systemic influence of hyperthyroidism on the orbital vessels can falsify the assessment of local inflammation severity.Methods: To eliminate the influence of systemic hyperthyroidism on orbital vessels, we compared peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) in the central retinal artery (CRA), and ophthalmic artery (OA) in patients with hyperthyroidism in the course of Graves' disease without any detectable orbital changes, (CAS = 0) and toxic nodular goiter.Results: There were no statistically significant differences between the patients with Graves' disease and toxic nodular goiter in terms of the examined parameters in either of the arteries. However, higher PSV and RI and lower EDV in the CRA as well as higher PSV and EDV and unchanged RI in the OA were found in the patients with Graves' diseases and toxic nodular goiter.Conclusion: Hyperthyroidism and hyperthyroidism-induced hyperkinetic flow have a systemic influence on the orbital vessels, irrespective of the cause of hyperthyreosis. Thus, it is necessary to compare the flow parameters in retrobulbar vessels in Graves' patients with the toxic nodular goiter patients to eliminate the systemic influence of hyperthyroidism on the orbital vessels.

Highlights

One of the methods for the evaluation of orbital inflammation related with Graves’ disease is the analysis of flow in retrobulbar vessels using Doppler imaging
Diagnosis of both Graves’ disease and toxic nodular goiter was made by an endocrinologist based on clinical symptoms and biochemical tests [thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), TSH receptor autoantibodies (TRAb), and anti-thyroid peroxidase antibodies (ATPO)], and was consistent with the published criteria [11, 12]
No statistically significant differences were found in peak systolic velocity (PSV), enddiastolic velocity (EDV) and resistance index (RI) in the CRA, and in EDV and RI in the OA between euthyroid and subclinically hyperthyroid patients in either patient group (Graves’ disease and goiter)

Summary

Introduction

One of the methods for the evaluation of orbital inflammation related with Graves’ disease is the analysis of flow in retrobulbar vessels using Doppler imaging. A vessel that is the most susceptible to orbital morphological changes is the superior ophthalmic vein, where one can notice decreased flow velocity, stasis, or retrograde flow irrespective of the phase of the disease (infiltration or fibrosis). Authors compare flow parameters in orbital arteries in patients with thyroidassociated orbitopathy with those in healthy volunteers [1, 2, 5]. The discrepancies between the measurements may result from differences in the classification criteria of patients with thyroid-associated orbitopathy based on the clinical activity score (CAS), developed by Mourits et al and from the adopted study methods [6]. Supplementing the CAS with a retrobulbar flow analysis with Doppler imaging could translate into improved diagnosis and treatment efficacy, both regarding treatment initiation and type of therapy

Objectives

Methods

Results

Discussion

Conclusion