SAT-579 A Rare Presentation of Ophthalmopathy in a Patient with Hashimoto's Hypothyroidism

Ophthalmopathy is a known disorder that consists of inflammation of the orbits and periorbital tissues that can be commonly seen in systemic autoimmune diseases such as Graves. On the other hand, ophthalmopathy associated with Hashimoto's thyroiditis is a rare presentation that is under-reported in the literature. A 58-year-old female was admitted to the hospital for sudden onset of double vision with subsequent progression of vision loss in her left eye. Prior to admission, she had a known history of hypothyroidism for several years with non-compliance to replacement therapy. On admission, patient's thyroid function tests (TFTs) showed a TSH of 37.95 and a Free T4 of 0.6 along with elevated thyroid peroxidase (TPO) antibodies at 58.3, thus confirming the diagnosis of Hashimoto's hypothyroidism. Upon Ophthalmology consultation, she was noted to have orbitopathy, namely left eye rectus lateralis paralysis, that was attributed to the TPO antibodies. The patient was started on appropriate thyroid hormone replacement with improvement of TFT values within a few days. However, the patient continued to have persistent diplopia despite therapy. At this time, the patient was started on prednisone 20 mg daily for a total of 2 weeks. At the end of the steroid therapy, complete resolution of the orbitopathy with vision improvement was noted. Hashimoto's ophthalmopathy is a rare form of orbitopathy especially when compared to the well-known version in Graves' Disease. In the literature, there has been some case studies that looked at the association of Hashimoto's thyroiditis with diplopia. In one study, the authors noted that both Graves' and Hashimoto's diseases accounted for 6% of thyroid associated eye disease while Graves' disease accounted for the majority of cases. The authors also noted that patients with Hashimoto's thyroid-associated eye disease were: older, had a longer duration of Hashimoto's diagnosis, were less likely to have co-existent other autoimmune disease, had a positive history of tobacco usage, and had elevated values of thyroid stimulating antibodies (TSAb). The authors also established a positive correlation between the occurrence and severity of thyroid associated eye disease in relation to increasing TSAb levels.1 Although Hashimoto's associated ophthalmopathy is a rare presentation of this autoimmune thyroid disorder, it is prudent to have a high index of suspicion in order to institute appropriate anti-inflammatory therapy such as steroid therapy for early resolution of eye symptoms. Early identification and treatment can stop the disease progression and prevent complications such as blindness due to optic nerve compression. 1. Kan E, Kan EK, Ecemis G, Colak R. Presence of thyroid-associated ophthalmopathy in Hashimoto's thyroiditis. International Journal of Ophthalmology. 2014;7(4):644-647. doi:10.3980/j.issn.2222-3959.2014.04.10.