Abstract

Background: Approximately 25% of patients with Hashimoto thyroiditis (HT) have mild eye signs whilst 3% have typical ophthalmopathy with severe congestive changes, proptosis and eye muscle damage. In Graves ophthalmopathy, there is evidence that the orbital reactions are closely associated with those in the thyroid, either through autoantibody cross-reactivity or by homing of sensitized thyroid lymphocytes to the orbits. The relationship between the thyroidal and orbital tractions in HT is less clear. 

Clinical Subjects: We studied 72 patients with HT with (n = 23) and without (n = 49) ophthalmopathy, correlating their real-time thyroid ultrasound findings with the presence of not of ophthalmopathy.

Methods: We have developed a 5-stage classification system for the inflammatory changes seen on thyroid ultrasonography in patients with HT. The early signs are characterised by features of mild inflammation in a normal or slightly enlarged thyroid through to the late stages in which black “holes” are seen in place of the destroyed thyroid tissue, and the gland becomes shrunken, scarred and avascular.

Results: Although we found no significant correlation between thyroid ultrasound stages and the presence or not of ophthalmopathy, patients with more severe ultrasound changes (stages 3 - 5) had a greater prevalence of ophthalmopathy than those early/mild changes (stages 1, 2). 

Conclusion: A larger prospective study needs to be carried out to further address this relationship and whether or not the thyroid inflammation and the orbital inflammation occur in parallel, as in Graves disease, or independently. If the latter, it would suggest that HT and the ophthalmopathy are separate autoimmune disorders. 

Keywords: Hashimoto Thyroiditis; Ophthalmopathy; Ultrasonography; Thyroid Autoimmunity

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