Journal List > J Korean Ophthalmol Soc > v.61(3) > 1144112

Chung and Kim: Acquired Strabismus and Diplopia as Initial Presentation Signs of Hyperthyroidism and Thyroid Eye Disease

Abstract

Purpose

We evaluated the clinical characteristics of patients who recently acquired strabismus and diplopia as the initial presentations of hyperthyroidism and thyroid eye disease (TED).

Methods

The medical records of patients with acquired strabismus and diplopia who visited our clinic for evaluation between January 2017 and December 2018 were retrospectively reviewed; patients diagnosed initially with hyperthyroidism and TED were included in this study.

Results

A total of 410 patients were referred to our clinic for the evaluation and treatment of diplopia. Among these patients, 12 (2.9%, 12/410) showed acquired strabismus and diplopia as the initial presentation signs of hyperthyroidism and TED. The mean age of onset of diplopia was 54.7 years (range, 18–78 years). Nine patients (75%, 9/12) were male. Six male patients were active smokers at the initial presentation. Hypotropia was the most common type of strabismus (83.3%, 10/12). The mean angle of hypodeviation was 17.5 prism diopters (PD) (range, 4–40 PD). One patient showed exotropia with hypotropia and one patient showed esotropia with a bilateral up gaze limitation. Four male patients (all active smokers) underwent strabismus surgery, and one female patient underwent orbital decompression surgery.

Conclusions

The incidence of acquired strabismus and diplopia as the initial presentation sign of hyperthyroidism was predominant in male patients. Hypotropia was the most common type of strabismus. Male patients who smoked were more likely to show progression to a severe clinical course than female patients.

Figures and Tables

Figure 1

Patient 5 with nine diagnostic position at the initial presentation. (A) Patient demonstrated hypotropia in the right eye in the primary position with up gaze limitation. (B) Magnetic resonance imaging of the brain showed enlargement of the inferior rectus muscle in right eye.

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Figure 2

Patient 9 with nine diagnostic position at the initial presentation. (A) Patient demonstrated esotropia and up gaze limitation of the both eyes. (B) Magnetic resonance imaging of the brain showed enlargement of the inferior rectus muscle and medial rectus muscle in the both eyes.

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Table 1

Clinical characteristics of patients who have acquired strabismus and diplopia as the initial presentation signs of hyperthyroidism and thyroid eye disease

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PD = prism diopters; M= male; HoT = hypotropia; XT = exotropia; F = female; ET = esotropia.

Notes

Conflicts of Interest The authors have no conflicts to disclose.

References

1. Biousse V, Newman JN. Neuro-ophthalmology illustrated. 2nd ed. New York: Theme;2016. chap. 13.
2. Maheshwari R, Weis E. Thyroid associated orbitopathy. Indian J Ophthalmol. 2012; 60:87–93.
crossref
3. Bahn RS. Graves' ophthalmopathy. N Engl J Med. 2010; 362:726–738.
crossref
4. Lazarus JH. Epidemiology of Graves' orbitopathy (GO) and relationship with thyroid disease. Best Pract Res Clin Endocrinol Metab. 2012; 26:273–279.
crossref
5. Kim WJ, Moon JS, Kim MM. Exotropia and hypotropia as the initial presentation sign of thyroid eye disease in an 18-year-old man. J AAPOS. 2018; 22:71–73.
crossref
6. Mourits MP, Prummel MF, Wiersinga WM, Koornneef L. Clinical activity score as a guide in the management of patients with Graves' ophthalmopathy. Clin Endocrinol (Oxf). 1997; 47:9–14.
crossref
7. Harrad R. Management of strabismus in thyroid eye disease. Eye (Lond). 2015; 29:234–237.
crossref
8. Tanda ML, Piantanida E, Liparulo L, et al. Prevalence and natural history of Graves' orbitopathy in a large series of patients with newly diagnosed graves' hyperthyroidism seen at a single center. J Clin Endocrinol Metab. 2013; 98:1443–1449.
crossref
9. Bartley GB, Fatourechi V, Kadrmas EF, et al. The incidence of Graves' ophthalmopathy in Olmsted County, Minnesota. Am J Ophthalmol. 1995; 120:511–517.
crossref
10. Bartley GB. The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota. Trans Am Ophthalmol Soc. 1994; 92:477–588.
11. Marcocci C, Bartalena L, Bogazzi F, et al. Studies on the occurrence of ophthalmopathy in Graves' disease. Acta Endocrinol (Copenh). 1989; 120:473–478.
crossref
12. Rajendram R, Bunce C, Adams GG, et al. Smoking and strabismus surgery in patients with thyroid eye disease. Ophthalmology. 2011; 118:2493–2497.
crossref
13. Chen CS, Lee AW, Miller NR, Lee AG. Double vision in a patient with thyroid disease: What's the big deal? Surv Ophthalmol. 2007; 52:434–439.
crossref
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