Exploring The Clinical Features Of Patients With Graves’ Ophthalmopathy And The Value Of MRI In Their Evaluation

Background and PurposeGraves’ ophthalmopathy(GO),also known clinically as thyroid-related ophthalmopathy(TAO)or thyroid ophthalmopathy,is one of the major extra-thyroidal manifestations of Graves’ disease(GD).The clinical activity score(CAS)is used to assess activity,but this assessment is subjective.Therefore,this study analyzed the relationship between serological parameters and magnetic resonance imaging(MRI)measurements and the activity of patients with GO.The aim of this study was to evaluate the value of serological indicators and MRI-measured parameters for the assessment of GO activity,and to provide data and theoretical support for clinical diagnosis and treatment.MethodsPart I:A total of 144 patients were included,and different numbers of patients were included for retrospective analysis according to the data of each item.The medical records and relevant phlebotomy indexes of GO patients were collected through the medical record system of Southern Hospital of Southern Medical University,and the SPSS25.0 system was used to analyze the differences between groups of inactivity and activity and the presence or absence of diplopia for each phlebotomy index,and binary Logistic regression was used to analyze the factors associated with activity.Part Ⅱ:A total of 140 patients were included,and the MRI T2-weighted imaging(T2-weighted imaging,T2WI)of GO patients was used to measure the maximum transverse diameter of the four extraocular muscles,medial fat and optic nerve,orbital area,and proptosis,and the SPSS25.0 system was used for activity and the presence or absence of The intergroup analysis of diplopia was performed,followed by subgroup analysis of activity by gender,age,and history of hormonal shock or not,respectively.Binary Logistic regression was used to analyze the correlates of diplopia,and ROC curves were used to assess the diagnostic efficacy of GO.ResultsPart I:Age,thyrotropin(TSH),free thyroxine(FT4),very low density lipoprotein cholesterol(VLDL-C),and complement component 4(C4)were statistically different between patients in the active GO group and those in the inactive GO group,and C4 were statistically different,and binary Logistic regression analysis showed a correlation between the history of hormonal shock,FT4,thyrotropic receptor autoantibodies(TRAb),and C4 and the activity of GO patients.correlation.Age,smoking history,and TRAb were statistically significant in the diplopia GO group versus the no diplopia GO group.Part II:There were statistically significant differences in the 4 extraocular muscles and medial fat in the right eye and the 4 extraocular muscles and orbital area in the left eye between the two groups in the inactive GO group and the active GO group.There was a statistically significant difference in the comparison of the 4 extraocular muscles between groups in the female subgroup,whereas there was no statistically significant difference in the 4 extraocular muscles in the male group,except for the medial rectus muscle of the right eye.The statistically significant indicators were generally consistent between the age and no history of hormonal shock subgroups.There were statistically significant differences between the upper and lower rectus muscles of both eyes in the no diplopia and diplopia GO groups,and TRAb and the diameter of the lower rectus muscle of the right eye correlated with diplopia in GO patients.Optimal diagnostic value could be obtained by judging the clinical activity of GO by the maximum diameter of the external rectus muscle ≥5.98 mm in both eyes and by the maximum diameter of the internal rectus muscle≥5.90 mm in both eyes.Conclusion1.Age and VLDL-C were greater in the active GO group than in the inactive group.2.History of hormone therapy,TRAb,FT4 and C4 correlated with the activity of GO patients.3.MRI T2WI sequences had good value in assessing the activity of GO,more so in female patients.4.Older GO patients with a history of smoking may be more likely to develop diplopia.5.TRAb and right inferior rectus diameter correlated with diplopia in GO patients.6.The maximum diameter of the external rectus muscle of both eyes≥ 5.98 mm and the maximum diameter of the internal rectus muscle of both eyes≥ 5.90 mm were used to determine the clinical activity of GO to obtain the best diagnostic value.