Eye symptoms in patients with benign thyroid diseases

Thyroid diseases may cause a variety of functional and structural body changes, including eye and vision abnormalities, which can have a negative impact on a patient’s well-being. However, only a few studies on the impact of other benign thyroid diseases on the visual process are available in the literature. In this study, using the Polish version of the thyroid-specific quality of life (ThyPROpl) questionnaire, we aimed to determine the self-reported influence of benign thyroid diseases (e.g., nodular goiter, toxic nodular goiter, Graves’ disease, thyroid orbitopathy, Hashimoto’s thyroiditis, and surgical hypothyroidism) on patients’ eyes and vision. This was a prospective study. In total, 374 randomly selected euthyroid patients and 255 control subjects responded to the ThyPROpl questionnaire and the results were evaluated. Nearly 69% of the respondents reported that the most frequent condition was “reduced sight.” Men most often reported wet/tearing eyes (66%). The occurrence of eyelid sacks or swollen eyelids (64%), ophthalmalgia (62%), and eye dryness (61%) was marked almost as often. In total, 29% of the patients reported diplopia, and it was found to be most prevalent among those with thyroid orbitopathy. Other complaints were similarly prevalent among all the subgroups. A positive correlation was also observed between the scores of the “eye symptoms” and other ailments. Except for swelling around the lower eyelids, patients with thyroid diseases more frequently experienced all of the ocular complaints analyzed in this study compared with controls. This study showed that eye complaints are common in patients with benign thyroid diseases and ocular disturbances have a negative impact on the overall quality of life of patients.

Treatment of Graves’ Disease With a Combination of Low Iodine Diet and Potassium Iodide Plus Radioactive Iodine Treatment

Introduction: Graves’ disease (GD) is usually treated with radioactive iodine I131 (RAI), thionamide or surgery. Of these, RAI remains the safest and most efficacious treatment. We report 3 patients with GD who were treated with low iodine diet (LID), followed by RAI and subsequent potassium iodide (SSKI) administration.Case series:Patient 1 - A 50-year-old male presented with weight loss, heat intolerance and palpitations. Physical examination: HR 120 bpm, BP 110/80mmHg, no evidence of thyroid orbitopathy. Thyroid: 50 grams diffusely enlarged and brisk DTR. Lab findings: TSH 0.001, FT4 4.2, total T3 410, TSI 172. A thyroid scan revealed diffuse uptake 72% at 4-hours. He was diagnosed with GD and treated with methimazole. Three weeks later a CBC showed an absolute neutrophil count 820. After discontinuing methimazole, he was placed on prednisone 40mg daily and LID. Two weeks later (24-hours urine iodine <50 mcg), he received 15mCi I131. 72 hours later he was administered SSKI one drop BID for 3 days. Four weeks after RAI, TFT was normal. Two months later, he required levothyroxine treatment for hypothyroidism. Patient 2 - A 23-year-old female presented with weight loss and nervousness. Physical examination revealed HR 110 bpm, BP 100/70 mmHg, no thyroid orbitopathy, a diffusely enlarged thyroid. Serum TSH <0.005, FT4 3.9, total T3 398, TSI 149. Thyroid uptake showed 70% at 24-hours. Patient was started on methimazole and atenolol. Four weeks later she developed severe generalized erythematous rash. After treating with prednisone for one week she was placed on LID and treated with 15 mCi I131. Six weeks later TSH was 0.4 with a free T4 of 1.8 and four months later she required levothyroxine therapy for hypothyroidism. Patient 3 - A 40-year-old male presented with atrial fibrillation and hyperthyroidism. Patient received treatment for atrial fibrillation and physical examination confirmed heart rate 78 (on treatment), no evidence of thyroid orbitopathy, and diffusely enlarged thyroid. Serum TSH <0.005, FT4 3.1, total T3 298, TSI 231. Thyroid scan was consistent with GD with a 24-hr uptake of 62%. He refused to take methimazole due to fear of adverse side effects. After placing him on prednisone along with LID for 2weeks, he was treated with I131 15 mCi. 72 hours later he received SSKI one drop BID for 3 days. Prednisone was discontinued 2 weeks later. Six weeks following treatment, TSH was 1.1 with FT4 1.32. Patient remained euthyroid for the next 12 months of follow up. Discussion: LID given before RAI therapy has a potential of depleting total iodine pool which can increase the I131 uptake in the thyroid gland and facilitate β-radiation to the thyroid gland. SSKI following RAI can improve retention of I131 in the thyroid gland and reduce the recycling of radioactivity between the thyroid and the blood. In summary, a LID prior to RAI and SSKI following RAI treatment be beneficial in certain patients with GD.

Orbital Surgery: Evolution and Revolution

This article traces the development of orbital surgery and its subsequent modifications. It also points out the importance of defining one’s goal before embarking on orbital surgery. Although generally considered part of ophthalmology, surgery on the orbit has been relatively neglected and not routinely practiced. This article reviews the history of development of orbital surgery, both the revolutionary ideas and the evolutionary changes. There are multiple orbital lesions that do not need to be treated with surgery at all. These days chemotherapy, radation therapy, or even immunotherapy may be more appropriate. The most common orbital pathology, that is thyroid orbitopathy, the physician needs to decide whether or not the orbit needs to be decompressed or whether there are problems related to motility that can be dealt with by eye muscle surgery.

The eye: A diagnostic puzzle Descriptive observational study and review

A series of multicentric cases is reported, of which five institutions participated. The sample was of 17 patients, of which 11 belonged to our Hospital, the Dr. J. M. Cullen Hospital. All consulted for orbital and / or periorbital commitment. The commitment in men was 23.4% and 76.6% in women. The average age in years was 45.4 (17-69 years). Among the diagnoses found, five cases were IgG4-Related Disease, two cases of Erdheim Chester Disease, two Xantogranuloma, two xanthelasmas, a case of breast cancer metastases, a case of thyroid orbitopathy, a case of Amyloidosis with multiple myeloma, and three without diagnosis. Differential diagnoses found are reviewed.

Pattern of Orbital Diseases at a Tertiary Oculoplastic Center

Purpose: To determine the causes and frequency of orbital involvement by systemic disorders and non-ocular trauma at a tertiary Oculoplastic centre. Study Design: Descriptive cross-sectional retrospective study. Ophthalmology unit Place and Duration of Study: Department of Ophthalmology, Lady Reading Hospital Medical teaching Institute, Peshawar from January 2012 and Dec 2016. Methods: A total of 45 patients were included in this study. Patients’ demographics, clinical cause of orbitopathy and time delay between the problem noticed by the patient and presentation were recorded. Orbitopathy included the presence of corneal and conjunctival changes, optic nerve disorders, proptosis, orbital bone changes and soft tissue swelling of eyelids. The data was analyzed using SPSS software (version 22). The frequency (percentage) and mean ± standard deviation were reported for categorical variables. Results: Mean age of the patients was 28.89 ± 22.02 years. There were 26 (57.8%) males 19 (42.2%) females. Commonest disorder was Bacterial Infection in 16 (35.6%) patients followed by Thyroid orbitopathy, which was seen in 14 (31.1%) cases. Other causes included Leukemia, Lymphoma, Retrobulbar Hemorrhage, Neurofibromatosis, Neuroblastoma, Maxillary Osteosarcoma, Teratoma and Fungal Infection. Time delay between presentation of orbital swelling and first noticed by patient was 147.02 ± 155.18 weeks in male while in female the time delay was 148.79 ± 146.47 weeks. Conclusion: The commonest inflammation was due to thyroid, commonest infection was bacterial infection and commonest tumor was leukemia. Imaging and proper workup is important to properly treat any orbital disease. Key Words: Orbit, Ocular trauma, Neuroblastoma, Orbital lymphoma.

Hyperthyroidism associated with intraocular pressure and dry eye

Graves’ orbitopathy/ophthalmopathy (GO) also known as thyroid eye disease (TED),dysthyroid/thyroid-associated ophthalmopathy (TAO), is an autoimmune disorder representing thecommonest and most important extrathyroidal manifestation of Graves’ disease. Materials andMethods: This is a prospective study conducted for 2 years. A total of 60 established cases ofHyperthyroidism of all Age groups with either gender subjects who were diagnosed with Thyroidorbitopathy at hospitals were included in this study. History of ocular surgery or medications, thosedemonstrating the recent use of contact lenses, pregnant or lactating women. All the cases withsimilar presentation not proved to be Thyroid Orbitopathy and patients who did not report for thefollow-up were excluded from the study. Result: A total of 60 patients were examined. Of the 60cases analyzed, female preponderance was noted and 41-60 years age group had the highestincidence of thyroid orbitopathy. The most common presentation was found to be unilateral. Inferiorrectus muscle was the commonest muscle involved with 48.3% followed by Medial rectus muscle38.3%, Superior rectus muscle 23.3%, and Lateral rectus muscle involved least with 11.6% indescending order. None of the patients reported a loss of vision. Conclusions: Dry eye andincreased IOP have commonly seen outcomes that should be managed diligently. This potentialsight-threatening condition is seen worldwide and has many functional and cosmetic consequencesthat need to be recognized. Hyperthyroidism was significantly associated with the severity.