甲状腺眶病的鉴别诊断--模仿甲状腺眶病表现或活动的疾病。

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

甲状腺眼眶病(TO)是眼眶组织炎症最常见的原因,约占眼眶炎症总数的60%。应根据个人经验和标准诊断标准来诊断甲状腺眼眶病的炎症活动和严重程度。眼眶磁共振成像(MRI)不仅可用于识别肿胀和区分炎症活动性和非活动性TO,还可用于排除其他病变,如眼眶肿瘤或血管病变。然而,有一组疾病可模仿TO的临床表现,从而导致严重的诊断困难,尤其是当患者之前曾被诊断为甲状腺疾病时。单侧TO、单侧或双侧TO的患者既往无甲状腺疾病症状或伴随甲状腺疾病症状、无眼睑后缩症状、分歧性斜视、复视是该病的唯一症状,以及在一天结束时复视加重的病史等病例都可能带来诊断问题。持续的免疫抑制治疗缺乏明显疗效也应引起警惕,并导致 TO 的鉴别诊断。TO 的鉴别诊断及其活动性评估包括导致结膜和/或眼睑发红和/或肿胀的疾病,以及导致眼球运动障碍和复视障碍的其他原因。在本文中,作者回顾了可模拟 TO 或伪造 TO 炎症活动评估的最常见疾病。
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Differential diagnosis of thyroid orbitopathy - diseases mimicking the presentation or activity of thyroid orbitopathy.

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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