Abstract:

Objective  To investigate the clinical characteristics and the ⁹⁹Tc^m-octreotide scintigraph orbital imaging diagnostic values for pediatric thyroid associated ophthalmopathy (TAO). Design Retrospective case series. Participants During October 2008 to July 2015, 20 children were diagnosed as TAO in First Hospital of Shanxi Medical University. Methods We reviewed clinical manifestations, and medical records of 20 children in whom TAO was diagnosed. To evaluate the diagnostic value of the ⁹⁹Tc^m-octreotide scintigraph tomography, 13 children had TAO served as experimental group, 25 adult patients diagnosed as TAO and 30 healthy adult volunteers were involved as control group. The orbital ⁹⁹Tc^m-somatostatin analogues uptake ratio were compared among the groups. Main Outcome Measures Thyroid function，ophthalmic signs, exophthalmometry, ocular movement, B-mode ultrasound, 99Tcm-octreotide scintigraph tomography. Results Among 20 patients with a mean age of 10.85±1.42 years old with TAO, 5 of them were male and 15 female (F:M=3:1). 18(90%) cases had hyperthyroidism and 2(10%) were euthyroid. The mean duration of dysthyroid symptoms was 12.48±10.33 months (10 days~36 months) while the mean duration of ocular symptoms was 10.40±10.17 (1~36) months. TAO occurred bilaterally in 18 patients. Eyelid retraction was presented in 17 patients (85%), whereas the approximate frequency of exophthalmos was 19 patients (95%). Restrictive extraocular myopathy happened in 2 patients (10%). Extraocular enlargement was detected on B-mode ultrasound in 10 of 13(76.9%) patients who were evaluated. The frequencies of two enlarged muscles, three enlarged muscles and four enlarged muscles were 38.5%, 30.8% and 7.7%, respectively. Medial, inferior, superior and lateral rectuses enlarged in 75%, 65%, 40% and 10% of the orbits respectively. The UR level was not significantly different in children patients and adult patients (P=0.294), while in both patient group it was significantly higher compared to the normal adult control group (P＜0.01). UR did not show difference between bilateral eyes (P=0.372). Conclusion Bilateral eye involvement, eyelid retraction and exophthalmos were the most common clinical signs of pediatric TAO. Pediatric patients with abnormal thyroid function should be routinely followed up for at least 1 year by eye doctorts. The ⁹⁹Tc^m-somatostatin analogue orbital imaging has diagnostic value for pediatric TAO. (Ophthalmol CHN, 2016, 25: 366-370)

Key words: children, thyroid associated ophthalmopathy, orbital imaging