Asymmetric proptosis in thyroid eye disease.

PURPOSE: Patients with thyroid eye disease (TED) can present with asymmetric disease. The purpose of this study was to evaluate the prevalence of asymmetric TED in an Australian cohort and investigate clinical, biochemical, and radiological associations of asymmetric TED. METHODS: This was a retrospective study of patients with TED who underwent Hertel exophthalmometry and orbital computed tomography (CT) scans. Asymmetry was defined as a difference in the globe protrusion of ≥ 3 mm using Hertel exophthalmometry. Data was collected on patient demographics, clinical disease presentation, thyroid function tests and antibody levels. Muscles volumes were determined by manually segmenting the extraocular muscles on CT scans using a commercially available software. RESULTS: 172 orbits from 86 patients were included in the study. 28 (33%) patients had asymmetric TED. No significant differences were observed in age, gender, thyroid hormone status, anti-thyroid peroxidase levels, thyroid stimulating hormone receptor antibodies, disease activity status, or dysthyroid optic neuropathy between the asymmetric and non-asymmetric groups. The extraocular muscle volumes were significantly higher in the asymmetric orbit compared to its contralateral orbit. CONCLUSION: Asymmetric TED is a reasonably common occurrence in the course of TED. It is associated with higher extraocular muscle volumes, suggesting muscle enlargement as one of the underlying contributors to asymmetric proptosis. Thyroid eye disease should be considered in the differential of asymmetric orbital inflammatory disease.

Extraocular muscle enlargement in dysthyroid optic neuropathy.

OBJECTIVE: To investigate extraocular muscle volumes in thyroid eye disease (TED) patients with and without dysthyroid optic neuropathy (DON). DESIGN: Retrospective cohort study. PARTICIPANTS: TED patients who had computed tomography of the orbits. METHODS: The extraocular muscles were manually segmented in consecutive axial and coronal slices, and the volume was calculated by summing the areas in each slice and multiplying by the slice thickness. Data were collected on patient demographics, disease presentation, thyroid function tests, and antibody levels. RESULTS: Imaging from 200 orbits was evaluated. The medial rectus, lateral rectus, superior muscle group, inferior rectus, and superior oblique volumes were significantly greater in orbits with DON compared with TED orbits without DON (p < 0.01 for all). There was no significant difference in the inferior oblique muscle volume (p = 0.19). Increase in volume of the superior oblique muscle showed the highest odds for DON. Each 100 m3 increase in superior oblique, lateral rectus, inferior rectus, medial rectus, and superior muscle group volume was associated with 1.58, 1.25, 1.20, 1.16, and 1.14 times increased odds of DON. CONCLUSION: All extraocular muscle volumes except for the inferior oblique were significantly greater in DON patients. Superior oblique enlargement was associated with the highest odds of DON, suggesting superior oblique enlargement to be a novel marker of DON.

Prehabilitation for general surgery: a systematic review of randomized controlled trials.

BACKGROUND: Prehabilitation seeks to optimize patient health before surgery to improve outcomes. Randomized controlled trials (RCTs) have been conducted on prehabilitation, however an updated synthesis of this evidence is required across General Surgery to inform potential Supplementary discipline-level protocols. Accordingly, this systematic review of RCTs aimed to evaluate the use of prehabilitation interventions across the discipline of General Surgery. METHODS: This study was registered with PROSPERO (CRD42023403289), and adhered to PRISMA 2020 and SWiM guidelines. PubMed/MEDLINE and Ovid Embase were searched to 4 March 2023 for RCTs evaluating prehabilitation interventions within the discipline of General Surgery. After data extraction, risk of bias was assessed using the Cochrane RoB 2 tool. Quantitative and qualitative data were synthesized and analysed. However, meta-analysis was precluded due to heterogeneity across included studies. RESULTS: From 929 records, 36 RCTs of mostly low risk of bias were included. 17 (47.2%) were from Europe, and 14 (38.9%) North America. 30 (83.3%) investigated cancer populations. 31 (86.1%) investigated physical interventions, finding no significant difference in 16 (51.6%) and significant improvement in 14 (45.2%). Nine (25%) investigated psychological interventions: six (66.7%) found significant improvement, three (33.3%) found no significant difference. Five (13.9%) investigated nutritional interventions, finding no significant difference in three (60%), and significant improvement in two (40%). CONCLUSIONS: Prehabilitation interventions showed mixed levels of effectiveness, and there is insufficient RCT evidence to suggest system-level delivery across General Surgery within standardized protocols. However, given potential benefits and non-inferiority to standard care, they should be considered on a case-by-case basis.

Imaging of dysthyroid optic neuropathy.

Dysthyroid optic neuropathy (DON) is a sight-threatening complication of thyroid eye disease and can lead to permanent vision loss if not treated early. Imaging with computed tomography (CT) or magnetic resonance imaging (MRI) can aid in the diagnosis and early recognition of DON. A number of quantitative and qualitative imaging features have been associated with DON. This article summarises the definition, prevalence, and utility of these radiological findings in the diagnosis of DON.