Research Article
Volume 11 Issue 4 - 2020
Correlation between Thyroid Ultrasound Findings and Eye Signs in Patients with Hashimoto Thyroiditis
Wei Lee1, Hooshang Lahoot1 and Jack R Wall1,2*
11The Department of Medicine, Nepean Clinical School, The University of Sydney, Australia
22Department of Health Sciences, Macquarie University, Sydney, NSW, Australia
*Corresponding Author: Jack R Wall, Department of Health Sciences, Macquarie University, Sydney, NSW, Australia.
Received: February 26, 2020; Published: March 14, 2020


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


  1. Wall JR. “Use of real-time thyroid ultrasonography by endocrinologists - a work in progress”. ASUM Ultrasound Bulletin 10 (2007): 24-29.
  2. Nanan R., et al. “Remission of Hashimoto’s thyroiditis at puberty in a 12-year-old girl documented by changes in thyroid ultrasonography”. Thyroid 20.10 (2010): 1187-1190.
  3. Lahooti H., et al. “Association of the CASQ1 gene rs3838216 with Graves’ ophthalmopathy and Hashimoto’s thyroiditis in patients with thyroid autoimmunity”. Ophthalmology Research 2.6 (2014): 281-290.
  4. Tjiang H., et al. “Eye and eyelid abnormalities are common in patients with Hashimoto’s thyroiditis”. Thyroid 20.3 (2010): 287-290.
  5. Gopinath B., et al. “A case of Hashimoto’s thyroiditis presenting with chronic upper eye lid retraction and positive calsequestrin and collagen XIII antibodies”. International Journal of Endocrinology and Metabolism 6 (2008): 34-37.
  6. Gopinath B., et al. “Eye signs and serum eye muscle and collagen XIII antibodies in patients with transient and progressive thyroiditis”. Thyroid 17.11 (2007): 1123-1129.
  7. Young TK., et al. “Sight Threatening Thyroid Eye Disease Complicating Hashimoto’s Thyroiditis”. Endocrinology and Metabolic Syndrome 6.4 (2017): 1-4. 
  8. Kan E., et al. “Presence of thyroid-associated ophthalmopathy in Hashimoto’s thyroiditis”. International Journal of Ophthalmology 7.4 (2014): 644-647.
  9. El Kochairi I., et al. “Risk factors for ophthalmopathy in patients with Hashimoto’s thyroiditis”. Ophthalmology Research 4 (2014): 177-188.
  10. Wall JR., et al. “Thyroid stimulating immunoglobulins (TSI) as measured in a reporter bioassay are not detected in patients with Hashimoto’s thyroiditis and ophthalmopathy or isolated upper eyelid retraction”. Clinical Ophthalmology 8 (2014): 2071-2076.
  11. Southgate K., et al. “A receptor assay for the measurement of TSH receptor antibodies in unextracted serum”. Clinical Endocrinology 20.5 (1984): 539-543. 
  12. Gopinath B., et al. “Can Autoimmunity against calsequestrin explain the eye and eyelid muscle inflammation of thyroid eye disease?” Orbit 28.4 (2009): 256-261.
  13. McKenzie JM. “Review: Pathogenesis of Graves' Disease: Role of the Long-acting Thyroid Stimulator”. Journal of Clinical Endocrinology and Metabolism 25 (1965): 424-431. 
  14. Wiersinga WM., et al. “Therapeutic Outcome of Prednisone Medication and of Orbital Irradiation in Patients with Graves' Ophthalmopathy”. Ophthalmologica 197.2 (1988): 75-84.
  15. Mourits MP., et al. “Clinical activity score as a guide in the management of patients with Graves' ophthalmopathy”. Clinical Endocrinology 47.1 (1997): 9-14.
  16. Burch HB and Wartofsky L. “Graves' ophthalmopathy: Current concepts regarding pathogenesis and management”. Endocrine Reviews 14.6 (1993): 747-793.
  17. Bahn RS. “Current Insights into the Pathogenesis of Graves’ Ophthalmopathy”. Hormone and Metabolic Research 47.10 (2015): 773-777.
Citation: Jack R Wall., et al. “Correlation between Thyroid Ultrasound Findings and Eye Signs in Patients with Hashimoto Thyroiditis”. EC Ophthalmology 11.4 (2020): 25-30.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

April Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the April issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before May 04, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to