Explore the Possibility of Early Clinical Diagnosis of Endocrine Ophthalmopathy Based on Eye Symptoms of Hyperthyroidism

Purpose: to study the possibility of early clinical diagnosis of endocrine ophthalmopathy based on ocular symptoms of hyperthyroidism. Patients and methods: we analyzed the prevalence of ocular symptoms of hyperthyroidism in 139 patients (278 orbits) with newly diagnosed endocrine ophthalmopathy (group 1), developed on the background of diffuse toxic goiter. The comparison group consisted of 80 patients (160 orbits) with newly diagnosed diffuse toxic goiter with no radiographic evidence of endocrine ophthalmopathy (group 2). All patients were examined by an ophthalmologist and endocrinologist. We analyzed the prevalence of ocular symptoms of hyperthyroidism (symptom Dalrymple’, Mobius’, Zenger’, and combinations thereof), often encountered in diffuse toxic goiter, flowing with endocrine ophthalmopathy, and/or lack thereof - in the group of “thyrotoxic exophthalmos”. We took into account the frequency distribution of these clinical signs, and their combinations. We analyzed the clinical sensitivity and specificity of diagnosis based on the three most common symptoms, and their combinations, associated both with thyrotoxicosis and with endocrine ophthalmopathy. Results: Dalrymple’ symptom, is more common in thyrotoxic exophthalmos than with endocrine ophthalmopathy (compared to 100.0% versus 61.9 %, p<0,001). This suggests that Dalrymple’ symptom leads to over diagnosis aspect endocrine ophthalmopathy. It is obvious that it can be used to recognize and thyrotoxic exophthalmos hyperthyroidism, but you cann’t credibly claim based on orbit about the presence of the disease. In this aspect, the greatest practical interest to provide a comparative assessment of the frequency of detection of symptoms of Mobius’ and Zenger’ and their combinations in a population of endocrine ophthalmopathy and in the group of thyrotoxic exophthalmos. Significantly more symptoms Zenger’ and Mobius’ developed with endocrine ophthalmopathy (66,2% and 81,7% vs. 7,5% and 15,0%, respectively, p<0,001). It had the highest sensitivity and symptoms of Mobius’, Zenger’ (reached 83.5% and 66.2%, respectively). It proved to be less sensitive symptom Dalrymple’ (61.9%) and a combination of these symptoms. The highest specificity (98.1%) showed a combination of three symptoms were less specific symptoms tandem Zenger’ and Mobius’ (93.8%) and the tandem symptom Dalrymple’ with Zenger’ symptoms (92.5%). In other words, identifying a patient at the
same time the three symptoms: Mobius’, Dalrymple’ and Senger’, or both symptoms and Senger’, Mobius’ allows to clinically diagnose with a high probability his endocrine ophthalmopathy, and conversely, a negative result of the test eliminates the desired highly specific disease. Conclusion: The presented results of statistical studies reveal the possibility of early clinical diagnosis of subclinical forms of endocrine ophthalmopathy based on monosymptom thyrotoxicosis Mobius’ and Zenger’, their tandem, as well as combinations of the symptoms of Mobius’, Zenger’ and Dalrymple’.

endocrine ophthalmopathy, the symptoms of hyperthyroidism, diagnosis of endocrine ophthalmopathy

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