J Korean Ophthalmol Soc.  2022 Oct;63(10):807-813. 10.3341/jkos.2022.63.10.807.

Clinical Manifestations of Thyroid-associated Ophthalmopathy Accompanied by Thyroid Cancer

• Lee SH
• Lee JK

• KMID: 2534433
• DOI: http://doi.org/10.3341/jkos.2022.63.10.807

Abstract

Purpose
To analyze the clinical manifestations of thyroid-associated ophthalmopathy accompanied by thyroid cancer.
Methods
We performed a retrospective chart review of 33 patients diagnosed at our ophthalmology department with both thyroid- associated ophthalmopathy and thyroid cancer. We performed thyroid function tests at the first visit and at diagnosis of the thyroid cancer, and recorded the type of thyroid cancer, thyroidectomy history, clinical activity score (CAS), exophthalmometry, margin reflex distance (MRD) 1, diplopia, follow-up duration of ophthalmopathy, and ocular treatments. We divided patients into two groups according to the time of diagnosis of thyroid ophthalmopathy and thyroid cancer.
Results
The average age of the 33 patients was 45.55 years, and eight and 25 were males and females, respectively. The average CAS score, exophthalmometry measurement, and MRD1 were 2.00 ± 1.67, 19.28 ± 3.24 mm, and 4.52 ± 1.58 mm, respectively. Patients whose ocular symptoms preceded the diagnosis of thyroid cancer tended to have a higher thyroid hormone level, CAS score, and exophthalmometry measurement, and required more ocular treatments, compared to the other patients. The average thyroid auto-antibody levels were increased in both groups. In patients whose ophthalmopathy preceded the thyroid cancer, exophthalmometry measurements were significantly decreased after thyroidectomy.
Conclusions
It is crucial to identify ophthalmopathy in association with thyroid cancer. Patients whose ocular symptoms started before the diagnosis of thyroid cancer may present with hyperthyroidism and severe ocular symptoms, and may need ocular treatments. Patients should be informed that thyroid-associated ophthalmopathy may develop after thyroidectomy or radioiodine therapy, and their ocular symptoms should be closely monitored.

Keyword

Radioactive iodine ablation; Thyroid cancer; Thyroid-associated ophthalmopathy; Thyroidectomy