Clinical and radiological diagnostic and predictive features of dysthyroid optic neuropathy in a multi-ethnic thyroid eye disease population
Author: Malik Moledina
Base Hospital / Institution: Western Eye Hospital
Rapid fire oral presentation
Abstract ID: 24-272
Purpose
Dysthyroid Optic Neuropathy (DON) is a complication of Thyroid Eye Disease (TED) that can result in visual impairment. This study aims to identify the clinical and radiological diagnostic and predictive factors of DON.
Methods
Retrospective, comparative study of TED patients with and without DON in a tertiary multidisciplinary centre over 11 years. Inclusion criteria: age ≥ 18 and a diagnosis of TED with follow up for ≥6 months. Patients obtained axial T1 and coronal 3 mm STIR images.
Results
26 DON and 542 non-DON consecutive cases satisfied our criteria with a DON prevalence of 4.8%.
On univariate regression, the following radiological features increased the diagnostic likelihood of DON (Odds Ratios): Apical Crowding (AC) (29.2 p=0.000), Apparent Diffusion Coefficient (ADC) Values ≥1000 (9.2 p=0.004), significant Extra Ocular Muscle Enlargement (EOME) (3.7 p=0.001) and elevated Peri-Muscular Fat Signal Intensity (PMFSI)/EOM Signal Intensity (EOMSI) (5.3 p=0.000, 3.8 p=0.003). ROC curve with an AUC analysis for ADC values 0.84 (p=0.000). Threshold values of 1115 (78.9% sensitivity, 78.2% specificity), 797 (100% sensitivity, 24.8% specificity) and 1498 (31.6% sensitivity, 97.7% specificity) were identified.
We found on multivariable regression the following risks for developing DON (Odds Ratios): Age At TED Diagnosis (AATD) ≥53 years (5.2 p=0.002), presenting Gorman ≥3 (7.5 p=0.000), diabetes (5.7 p=0.002) and presenting TRAb ≥5.0 (2.9 p=0.035). ROC with an AUC value for presenting TRAb was 0.63 (p=0.043). Threshold values of 5.95 (59.1% sensitivity, 67.2% specificity), 0.55 (95.5% sensitivity, 16.6% specificity) and 29.85 (22.7% sensitivity, 91% specificity).
Conclusion
Significant EOME, AC and elevated ADC, PMFSI and EOMSI, are MRI features associated with a higher diagnostic likelihood of DON.
Diabetics, older AATD, and high presenting CAS, Gorman, and TRAb increase the risk of developing DON. Presenting and threshold, TRAb titres may be useful for risk stratification. Patients presenting with multiple risk factors should alert clinicians of the risk of sight-threatening complications.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Vickie | Lee | Western Eye Hospital |
| Nour | Houbby | Western Eye Hospital |
| Kunwar | Bhatia | Western Eye Hospital |
| Ahmed | Al-Nahrawy | Western Eye Hospital |
