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open access

Vol 75, No 1 (2024)
Review paper
Submitted: 2023-11-09
Accepted: 2023-11-27
Published online: 2024-02-21
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Differential diagnosis of thyroid orbitopathy — diseases mimicking the presentation or activity of thyroid orbitopathy

Mariusz Nowak1, Wojciech Nowak2, Bogdan Marek1, Beata Kos-Kudła3, Lucyna Siemińska1, Magdalena Londzin-Olesik3, Dariusz Kajdaniuk1
DOI: 10.5603/ep.98156
·
Pubmed: 38497384
·
Endokrynol Pol 2024;75(1):1-11.
Affiliations
  1. Pathophysiology Division, Department of Pathophysiology and Endocrinology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
  2. Science Students’ Association, Pathophysiology Division, Department of Pathophysiology and Endocrinology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
  3. Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland

open access

Vol 75, No 1 (2024)
Review Article
Submitted: 2023-11-09
Accepted: 2023-11-27
Published online: 2024-02-21

Abstract

Thyroid orbitopathy (TO) is the most common cause of orbital tissue inflammation, accounting for about 60% of all orbital inflammations. The inflammatory activity and severity of TO should be diagnosed based on personal experience and according to standard diagnostic criteria. Magnetic resonance imaging (MRI) of the orbit is used not only to identify swelling and to differentiate inflammatory active from non-active TO, but also to exclude other pathologies, such as orbital tumours or vascular lesions. However, a group of diseases can mimic the clinical manifestations of TO, leading to serious diagnostic difficulties, especially when the patient has previously been diagnosed with a thyroid disorder. Diagnostic problems can be presented by cases of unilateral TO, unilateral or bilateral TO in patients with no previous or concomitant symptoms of thyroid disorders, lack of symptoms of eyelid retraction, divergent strabismus, diplopia as the only symptom of the disease, and history of increasing diplopia at the end of the day. The lack of visible efficacy of ongoing immunosuppressive treatment should also raise caution and lead to a differential diagnosis of TO. Differential diagnosis of TO and evaluation of its activity includes conditions leading to redness and/or swelling of the conjunctiva and/or eyelids, and other causes of ocular motility disorders
and eye-setting disorders. In this paper, the authors review the most common diseases that can mimic TO or falsify the assessment of inflammatory activity of TO.

Abstract

Thyroid orbitopathy (TO) is the most common cause of orbital tissue inflammation, accounting for about 60% of all orbital inflammations. The inflammatory activity and severity of TO should be diagnosed based on personal experience and according to standard diagnostic criteria. Magnetic resonance imaging (MRI) of the orbit is used not only to identify swelling and to differentiate inflammatory active from non-active TO, but also to exclude other pathologies, such as orbital tumours or vascular lesions. However, a group of diseases can mimic the clinical manifestations of TO, leading to serious diagnostic difficulties, especially when the patient has previously been diagnosed with a thyroid disorder. Diagnostic problems can be presented by cases of unilateral TO, unilateral or bilateral TO in patients with no previous or concomitant symptoms of thyroid disorders, lack of symptoms of eyelid retraction, divergent strabismus, diplopia as the only symptom of the disease, and history of increasing diplopia at the end of the day. The lack of visible efficacy of ongoing immunosuppressive treatment should also raise caution and lead to a differential diagnosis of TO. Differential diagnosis of TO and evaluation of its activity includes conditions leading to redness and/or swelling of the conjunctiva and/or eyelids, and other causes of ocular motility disorders
and eye-setting disorders. In this paper, the authors review the most common diseases that can mimic TO or falsify the assessment of inflammatory activity of TO.

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Keywords

Graves’ and Basedow’s disease; thyroid orbitopathy; mimic diseases; differential diagnosis

About this article
Title

Differential diagnosis of thyroid orbitopathy — diseases mimicking the presentation or activity of thyroid orbitopathy

Journal

Endokrynologia Polska

Issue

Vol 75, No 1 (2024)

Article type

Review paper

Pages

1-11

Published online

2024-02-21

Page views

460

Article views/downloads

436

DOI

10.5603/ep.98156

Pubmed

38497384

Bibliographic record

Endokrynol Pol 2024;75(1):1-11.

Keywords

Graves’ and Basedow’s disease
thyroid orbitopathy
mimic diseases
differential diagnosis

Authors

Mariusz Nowak
Wojciech Nowak
Bogdan Marek
Beata Kos-Kudła
Lucyna Siemińska
Magdalena Londzin-Olesik
Dariusz Kajdaniuk

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