If thyroid ophthalmopathy is suspected, there should be a full assessment of thyroid function. This would normally include measurement of serum free thyroxine (FT4), thyroid stimulating hormone (TSH) and anti-thyroid antibodies, e.g. anti-thyroid peroxidase (TPO) antibodies. Many centres also measure free triiodo-thyronine (FT3) to give a more complete picture of thyroid function. If all of these tests are normal or negative, it is sometimes appropriate to measure thyroid-stimulating antibodies but this is a specialist test available in only few centres. Full blood count, ESR, CRP, Chest X ray and Sinus X ray may also be indicated.

Orbital imaging includes MRI and CT scan. MRI (T2-weighed including fat suppression STIR Sequence) helps to identify high signals in an active extra-ocular muscle1. An orbital CT scan aids the diagnosis and assists the surgeon during decompression.

Follow-up assessment is usually at 3 to 4 months and includes weight and blood pressure measurement, urinalysis and thyroid function tests. Patients treated with steroids and/or immunosuppression will also need a full blood count, blood glucose, urea and electrolytes and liver function tests. MRI may be repeated in order to assess the effect of immunosuppression.

1 Mayer E, Herdman G, Burnett C, Kabala J, Goddard P, Potts MJ. Serial STIR Magnetic Resonance Imaging Correlates with Clinical Activity Score in Thyroid Eye Disease. Eye 2001. 15: 313-318.

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