Endocrine Abstracts

JOINT1788

Introduction: Ophthalmic involvement in autoimmune thyroid diseases such as Graves’ disease is well known, while Hashimoto’s thyroiditis has rarely been implicated in the development of occular manifestations. Corneal ulceration is a serious complication that can jeopardize the visual prognosis. We report a clinical observation of an association between Hashimoto’s thyroiditis and corneal ulcer to describe this rare complication.

Clinical Case: Forty three years-old female patient, treated for hashimoto’s thyroiditis for 12 years on levothyroxine 100mg/d. The patient reported the onset of ocular redness aggravated by visual fog for 2 months. Workup noted whit cell blood at 7150/mm³, CRP at 55 mg/land TSH us at 18 uUI/ml. Fundus showed a visual acuity of 6/10 on the right and counting fingers at 0.5 m on the left, conjunctival hyperhemia with axial opacity and punctiform corneal perforation measuring 1*1 mm in the left eye. The patient was put on systemic corticosteroids with analgesic treatment. The evolution was marked by regression of local inflammatory signs. The patient was scheduled for amniotic membrane transplantation.

Discussion: Ophthalmological involvement is generally frequent in basedow’s disease, where it can occur in around 25-50% of cases, whereas this prevalence is only 2% in Hashimoto’s thyroiditis (1). Ocular lesions can occur at any time during the course of thyroid disease, sometimes 10 or even 20 years after the diagnosis of autoimmune thyroid disease (2). The pathogenesis of thyroid ophthalmopathy is based on the development of antibodies directed against both the thyroid gland and the orbit. Immunological mechanisms are represented by orbital infiltration by T lymphocytes recognizing orbital antigens and periocular muscles (3,4), secretion of cytokines and water-attracting glycosaminoglycans, and transformation of orbital fibroblasts into adipocytes, resulting in exophthalmos and inflammation of the eyeball with, in some cases, corneal fragility responsible for epithelial perforation. The presence of anti-TPO antibodies (in 90% of cases) testifies to their involvement in this pathogenesis (5,6).

Conclusion: Ocular complications in autoimmune thyroid disease (AITD) are a rare but sometimes serious entity that can be vision-threatening. They should therefore be screened in any patient being treated for an AITD.

Key Words:: thyroiditis, autoimmunity, Corneal ulceration.