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Asymmetric thyroid eye disease.

Khizar Rana1,2, Lee Shien S Yong1,2, Devanshu Garg1,2

  • 1Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, SA, Australia.

Saudi Journal of Ophthalmology : Official Journal of the Saudi Ophthalmological Society
|November 3, 2025
PubMed
Summary
This summary is machine-generated.

Asymmetric thyroid eye disease (TED) can now be objectively defined using computed tomography (CT) scans to measure extraocular muscle volumes. This radiological approach offers a more reliable method than current clinical assessments for diagnosing asymmetric TED.

Keywords:
Asymmetrycomputed tomographyorbit

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Area of Science:

  • Ophthalmology
  • Radiology
  • Endocrinology

Background:

  • Thyroid eye disease (TED) often presents with asymmetry.
  • Current definitions of asymmetric TED lack universal acceptance and rely on subjective clinical signs.
  • Objective radiological markers are needed for accurate diagnosis of asymmetric TED.

Purpose of the Study:

  • To evaluate asymmetric thyroid eye disease (TED) using an objective, radiological definition.
  • To establish a reliable method for quantifying asymmetry in TED patients.

Main Methods:

  • Retrospective study of TED patients using computed tomography (CT) scans of the orbits.
  • Manual segmentation to determine extraocular muscle volumes in each orbit.
  • Asymmetry defined by a ratio of total muscle volumes (≥1.4); unilateral disease if the opposite orbit showed no muscle enlargement.
  • Comparison with Hertel exophthalmometry measurements.

Main Results:

  • Fifteen percent of patients (15/100) exhibited asymmetric TED, with 9 having unilateral disease.
  • No correlation found between asymmetry and age, sex, thyroid status, or hormone levels.
  • A significant difference in exophthalmos was observed in asymmetric orbits; a 2.75 mm exophthalmos difference cutoff showed high accuracy (AUC 0.83) for identifying radiologically defined asymmetric TED.

Conclusions:

  • A universally accepted definition for asymmetric TED is lacking.
  • Clinical signs of asymmetry in TED are unreliable.
  • Objective radiological assessment of extraocular muscle volumes via CT scans provides a robust definition for asymmetric TED.