Korean J Fam Med.  2016 May;37(3):197-201. 10.4082/kjfm.2016.37.3.197.

Optic Neuropathy in Thyroid Eye Disease: A Case Series

• Salleh NA
• Seng WH
• Isa HD

• KMID: 2235112
• DOI: http://doi.org/10.4082/kjfm.2016.37.3.197

Abstract

In patients with thyroid disease, ocular involvement or thyroid ophthalmopathy is common, irrespective of their thyroid status. A common feature of thyroid eye disease is eyelid retraction, which leads to a classical starry gaze (Kocher sign). Treatment with radioactive iodine (RAI) is a known therapy for hyperthyroidism. However, this treatment may lead to or worsen thyroid ophthalmopathy. We report a case series of two patients with thyrotoxicosis, who presented with an atypical and subtle occurrence of thyroid eye disease (TED) soon after RAI therapy. One of the patients was initially diagnosed and treated for dry eyes; however, over a period of time, the patient's vision progressively deteriorated. Clinical and radiological investigations confirmed thyroid ophthalmopathy with low serum thyroid hormone levels. Both patients recovered well after immediate intensive intravenous steroid treatment. These cases highlight the importance of recognizing partial ptosis as one of the presenting signs of active TED among general practitioners and physicians.

Keyword

Radioactive Iodine; Proptosis; Ptosis; Thyroid Eye Disease; Relative Afferent Pupillary Defect

MeSH Terms

Exophthalmos
Eye Diseases*
Eyelids
General Practitioners
Humans
Hyperthyroidism
Iodine
Optic Nerve Diseases*
Thyroid Diseases
Thyroid Gland*
Thyrotoxicosis
Iodine