Bahçeci U A, Ozdek S, Pehlivanli Z, Yetkin I, Onol M
Gazi University School of Medicine, Besevler, Ankara, Turkey.
Eur J Ophthalmol. 2005 Sep-Oct;15(5):556-61.
To evaluate the changes in intraocular pressure (IOP), corneal thickness (CT), and retinal nerve fiber layer thickness (RNFLT) in patients with hypothyroidism before and after treatment.
A complete ophthalmic examination including visual acuity, IOP, anterior segment, and fundus examination together with CT and RNFLT measurements were performed for each patient with newly diagnosed hypothyroidism, at the initial diagnosis and the third and ninth months of the L-thyroxine treatment. Wilcoxon signed rank test and Spearman's correlation test were used for statistical evaluation of the results.
A total of 56 eyes of 28 patients were included in the study. The mean IOP and CT values were found to decrease with medical treatment (p = 0.000). There was no significant change in any of the RNFLT parameters measured with scanning laser polarimeter after L-thyroxine treatment (Wilcoxon, p > 0.05). The change in IOP levels was not correlated with the change in thyroid hormone levels (Spearman's correlation test, p > 0.05). The mean increase in serum free T3 and serum free T4 levels and the mean decrease in serum TSH levels at the ninth month of the therapy were found to be correlated with the decrease in CT in the left eyes (Spearman's correlation test, R > 0.4 and p < 0.05).
Hypothyroidism seems to cause a reversible increase in CT and IOP. IOP changes may be secondary to CT changes. RNFLT parameters measured with scanning laser polarimeter do not seem to be affected by hypothyroidism. When the CT is taken into account and the IOPs corrected for CT, the prevalence of glaucoma in hypothyroidism may not be as high as previously reported. This issue should be taken into account while assessing glaucoma in patients with hypothyroidism.
评估甲状腺功能减退症患者治疗前后眼压（IOP）、角膜厚度（CT）和视网膜神经纤维层厚度（RNFLT）的变化。
对每例新诊断的甲状腺功能减退症患者在初诊时以及左甲状腺素治疗的第三个月和第九个月进行全面的眼科检查，包括视力、眼压、眼前节和眼底检查以及角膜厚度和视网膜神经纤维层厚度测量。采用Wilcoxon符号秩检验和Spearman相关性检验对结果进行统计学评估。
本研究共纳入28例患者的56只眼。发现药物治疗后平均眼压和角膜厚度值降低（p = 0.000）。左甲状腺素治疗后，用扫描激光偏振仪测量的任何视网膜神经纤维层参数均无显著变化（Wilcoxon检验，p > 0.05）。眼压水平的变化与甲状腺激素水平的变化无相关性（Spearman相关性检验，p > 0.05）。治疗第九个月时血清游离T3和血清游离T4水平的平均升高以及血清促甲状腺激素水平的平均降低与左眼角膜厚度的降低相关（Spearman相关性检验，R > 0.4且p < 0.05）。
甲状腺功能减退症似乎导致角膜厚度和眼压可逆性升高。眼压变化可能继发于角膜厚度变化。用扫描激光偏振仪测量的视网膜神经纤维层参数似乎不受甲状腺功能减退症影响。考虑到角膜厚度并对眼压进行角膜厚度校正后，甲状腺功能减退症患者青光眼的患病率可能不像先前报道的那么高。在评估甲状腺功能减退症患者的青光眼时应考虑这一问题。
