Digital Infrared Thermal Imaging for Early Diagnosis and Disease Monitoring in Thyroid Eye Disease

The winner of the Fight for Sight/British Thyroid Foundation and Thyroid Eye Disease Charitable Trust Small Grant Award 2013 was Mr Matt Edmunds, University of Birmingham.

Presentations of Mr Edmunds' work have won two prizes:

  • The Ian Fraser Cup for best clinical research oral presentation at the Oxford Ophthalmological Congress, July 2016.
  • Poster 1st prize at European Society of Ophthalmic Plastic and Reconstructive Surgery (ESOPRS), Athens, September 2016.

A summary of his research is presented below.

We used a thermal imaging camera to take specialised photographs, measuringthe temperature of the tissues around the eyes, in patients with a thyroid condition in which the immune system becomes overactive, called Graves' Disease.

Around a quarter of those with Graves' Disease can go on to develop eye problems,with bulging eyes, redness and swelling, grittiness, soreness and pain, double vision and even blindness, known as Thyroid Eye Disease or TED. Unfortunately, it is currently impossible to predict which Graves' patients will develop TED and the existing methods for assessing patients are sometimes inaccurate and prone to misinterpretation.

We found three main important features in our thermal imaging analyses:

  1. As a group, those with Graves’ disease, even without the outward appearance of TED, had higher eye tissue temperatures than healthy people without any medical problems. This supports the existing medical evidence which tells us that around 70% of Graves’ patients without TED will have abnormalities on scans (e.g. CT or MRI) of their eye sockets.
  2. It was possible to detect early signs of inflammation, as shown by an increase in temperature around the eyes on thermal imaging photography, in Graves' disease patients going on to develop TED. This raises the possibility of making a diagnosis of TED at the earliest possible stage and therefore intervening with therapies before the unpleasant effects of TED take place.
  3. We were able to track temperature increases as Graves’ patients developed worsening TED, and then track a normalisation of temperature as the disease became inactive. This is important as this may permit us to make more accurate decisions about whether patients have worsening TED (and require treatment to control the overactive immune system) or stable TED (and may be at the point in their disease course where they can have surgery to improve their physical appearance and how their eyes function).

We hope that the technique of thermal imaging may be used alongside our skills of clinical assessment to aid in the early diagnosis and monitoring of patients with Graves’ disease and TED, particularly in decision-making about the timing and types of treatments that may be used.