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Standard radiological reporting of thyroid orbital imaging does not provide any correlation between thyroid eye related disease activity and radiological architecture. We propose the use of a radiological scoring system to determine the likelihood of active thyroid disease based on radiological changes.

Retrospective analysis of Computerised Tomography imaging of the orbits and correlation with thyroid eye disease (TED).

Analysis of CT orbital imaging of 20 patients (Male: Female, 7: 1, mean age 52.3 years) within 6 weeks of clinical diagnosis of TED. Imaging of 5 patients without a diagnosis thyroid eye disease was analysed as control. Radiological readers were blinded.
Radiological morphological data was collected and scored: Presence of proptosis (1), Increased extraconal and muscle fat (0-2), spindle muscular recti configuration (0-4), Quadrant of apical crowding (0-4), Tenting of optic nerve (0-1).
Seven patients had active thyroid eye disease (Clinical activity score (CAS) >/3) with radiological scoring (7-11; mean 9) and 13 patients had CAS score < 3 and a radiological scoring (1-4; mean 3). There was a positive correlation between CAS score and radiological scoring (r=0.856).

The radiological classification system provides an accurate radiological observational tool in determining the likelihood of active thyroid eye disease. Greater than 50% scoring was associated with active thyroid eye disease clinically. The information can guide radiologists’ reporting as well the treating physician and surgeon towards appropriate and timely management. Inter-assessor variability is a limiting factor. A larger and prospective study will increase our comprehension of radiological behaviour of thyroid eye disease.