Title: Clinical Profile of Thyroid Associated Ophthalmopathy and Relationship of Exophthalmos to Serum T3,T4 Status
Authors: Dr Ambily S, Dr Valsa T Stephen
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.153
Abstract
Introduction: The ocular symptoms may be the first manifestation in an endocrine disorder of thyroid. The ocular manifestations are frequent in hyperthyroid Graves disease but rarely associated with Hashimotos disease, thyroid carcinomas and euthyroid states. Euthyroid patients with TAO, eventually develop subtle or overt fluctuations in thyroid function.
Aim 1. The various ocular manifestatons of thyroid disorders were examined and the relationship of Graves exophthalmos to serum T3,T4 was studied.
Materials and Methods: A prospective study of 50 patients with TAO above 18 years were done over a period of 18 months with detailed ocular workup including measurement of proptosis with Hertels exophthalmometer. Routine investigations and thyroid function test were done. Stastical analysis was done using SPSS version 11. Clinical profile is presented in %. Association of the different grades of ophthalmopathy with T3T4 levels was analysed using student t- test. .
Results: The most common ocular manifestation was lid retraction i.e in 35 (70%) cases. This was closely followed by proptosis i.e 33 (66%) cases. Ocular myopathy occurred in 22(44%) cases. The most common ocular symptom was grittiness and burning sensation.(48%). 3 (6%)cases had optic nerve involvement. The
mean levels of serum T3(p=0.605) and T4(p=0.548) were not significantly different in different degrees of exophthalmos.
Conclusion: TAO is a common ocular entity in a patient who may present to ophthalmologist in a referral centre. Our role lies both in diagnosing the ocular malady and treating it as well as directing the patient for evaluation and treatment of systemic manifestations of the disease at the earliest.
Absence of definite association between T3,T4 levels and exophthalmos and its occurrence even in hypothyroid states supports immunological pathogenesis. Lab investigations are helpful to diagnose and monitor treatment aspects but newer investigative modalities are yet to be devised as definite markers of TAO.
Keywords: thyroid ophthalmopathy, exophthalmos, graves.
