Daumerie Ch, Duprez Th, Boschi A
Department of Endocrinology Université catholique de Louvain, St-Luc University Hospital, 1200 Brussels, Belgium.
Eur J Intern Med. 2008 Nov;19(7):531-6. doi: 10.1016/j.ejim.2008.01.013. Epub 2008 Mar 18.
Thyroid-Associated Orbitopathy (TAO) is an autoimmune disease characterized by orbital inflammation involving both adipose tissue and extra-ocular muscles (EOM). Whereas bilateral and possibly asymmetric orbital involvement is commonly found at radiological work-up, mono-orbital involvement is poorly documented, and ascribed to an initial and/or transient stage of subsequent bilateral TAO.
From a cohort of two hundred TAO patients, we selected retrospectively fourteen patients with initial clinical unilateral TAO. Five of them were excluded because of clinical bilateralization.
The sex ratio was 0.8 (4M, 5F), and mean age 44.6 years (range: 18-63). All patients were euthyroid when the initial magnetic resonance imaging (MRI) was performed. One patient was treated with Levothyroxine, because of subclinical hypothyroidism. Eight patients (six smokers) suffered from Graves' disease, of 1-4 years duration, for which they were treated with antithyroid drugs. A thyroidectomy was performed in two patients. None of the patients ever received radioiodine. Six patients remained euthyroid after stopping of the antithyroid regimen, and two became hypothyroid. Seven patients had active, and two severe TAO. Four of nine patients exhibited bilateralization of TAO on initial MRI. Clinical status ultimately improved or normalized in all. In two patients, MRI performed after 9 years demonstrated partial shrinkage of previously enlarged EOMs, together with fatty involution of involved muscles.
Unilateral TAO is not different and just as severe as bilateral TAO. At initial work-up MRI shows signs of bi-laterality in 45% (4/9), with mild involvement of 1 or 2 extra-ocular muscles. The radiological status of affected muscles does not normalize, even in the very long term.
甲状腺相关眼病（TAO）是一种自身免疫性疾病，其特征为眼眶炎症，累及脂肪组织和眼外肌（EOM）。虽然在影像学检查中常见双侧且可能不对称的眼眶受累，但单眼眶受累的记录较少，且被认为是随后双侧TAO的初始和/或短暂阶段。
在200例TAO患者队列中，我们回顾性选择了14例初始临床单侧TAO患者。其中5例因临床双侧化而被排除。
性别比为0.8（4例男性，5例女性），平均年龄44.6岁（范围：18 - 63岁）。所有患者在进行初始磁共振成像（MRI）时甲状腺功能正常。1例患者因亚临床甲状腺功能减退接受左甲状腺素治疗。8例患者（6例吸烟者）患有Graves病，病程1 - 4年，接受抗甲状腺药物治疗。2例患者接受了甲状腺切除术。所有患者均未接受过放射性碘治疗。6例患者在停用抗甲状腺治疗方案后甲状腺功能仍正常，2例患者出现甲状腺功能减退。7例患者患有活动性TAO，2例患有重度TAO。9例患者中有4例在初始MRI检查时出现TAO双侧化。最终所有患者的临床状态均有所改善或恢复正常。2例患者在9年后进行的MRI检查显示，之前增大的眼外肌部分萎缩，受累肌肉出现脂肪萎缩。
单侧TAO与双侧TAO无异，且同样严重。在初始检查时，MRI显示45%（4/9）的患者有双侧受累迹象，1或2条眼外肌轻度受累。即使在很长一段时间内，受累肌肉的放射学状态也不会恢复正常。
