Abstract
Purpose Graves' ophthalmopathy (GO) is the most common extra-thyroid manifestation of Graves' disease (GD). The Clinical Activity Score (CAS) has been widely used to evaluate GO inflammation severity and response to treatment; however, it is quite subjective. Infrared thermography (IRT) is a portable and low-cost device to evaluate local temperature and assess inflammation. The aim was to evaluate ocular temperature by IRT as an instrument for measuring inflammatory activity in GO and its correlation with CAS. Methods This is a cross-sectional study involving 136 consecutive GD patients (12 with CAS ≥ 3/7, 62 with CAS < 3 and 62 without apparent GO) with 62 healthy controls. Patients with active ophthalmopathy were prospectively evaluated. Exophthalmometry, CAS, and thermal images from caruncles and upper eyelids were acquired from all subjects. Results All eye areas of thermal evaluation had higher temperatures in GD patients with active ophthalmopathy (caruncles, p<0.0001; upper eyelids, p<0.0001), and it was positively correlated with CAS (r=0.60 and p<0.0001 at caruncles; r=0.58 and p<0.0001 at upper eyelids). No difference in temperature was found between other groups. Patients with active ophthalmopathy were prospectively evaluated after 6 or 12 months of the treatment and a significant difference was found in ophthalmometry (p=0.0188), CAS (p=0.0205), temperature of caruncles (p=0.0120), and upper eyelids (p=0.0066). Conclusions IRT was an objective and simple tool for evaluation and follow-up of inflammation in GO, allowed evidencing patients with significant inflammatory activity, and had a good correlation with the CAS score.
Highlights
Graves’ ophthalmopathy (GO) is the most common and serious extra-thyroid manifestation of Graves’ disease (GD), affecting about 50% of patients, and is usually bilateral, but may be unilateral [1, 2]
There were no significant differences of gender, age at diagnosis, age at the evaluation, thyroid disease duration, time of follow-up, presence of thyroglobulin antibodies (TgAb) and thyroid peroxidase antibodies (TPOAb), comorbidities, and radioiodine treatment between groups
The group with active ophthalmopathy had a higher rate of a detectable TSH receptor antibodies (TRAb) and methimazole users (83.33% versus 30.65 and 40.32%, p=0.0029) than the inactive ophthalmopathy and without ophthalmopathy groups of GD, respectively
Summary
Graves’ ophthalmopathy (GO) is the most common and serious extra-thyroid manifestation of Graves’ disease (GD), affecting about 50% of patients, and is usually bilateral, but may be unilateral [1, 2]. The signs and symptoms related to GO are eyelid retraction, ocular irritation, photophobia, dry eye, increased tearing, conjunctival redness, eyelid swelling, diplopia, ocular pain, ptosis, periorbital edema, proptosis, and even sight loss [3]. The scale evaluates soft tissue inflammation and assigns 1 point to each of the following manifestations: spontaneous orbital pain, gaze-evoked orbital pain, eyelid swelling, eyelid erythema, conjunctival redness, chemosis, and inflammation of caruncle or plica. For patient’s follow-up, 3 more items are included in CAS evaluation, which is increase of ≥ 2 mm in proptosis, decrease in the ocular excursion in any one direction of ≥ 8∘ and a decrease of acuity equivalent to 1 Snellen line.
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