Verma Rajesh, Gupta Mani, Mehta Vinod Kumar
Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
BMJ Case Rep. 2013 Jun 3;2013:bcr2013009920. doi: 10.1136/bcr-2013-009920.
Thyroid-associated orbitopathy (TAO) is a self-limiting auto-immune condition usually associated with Grave's disease. It is characterised by ocular pain, eyelid swelling, chemosis, proptosis and keratopathy. As the mechanism for ophthamoplegia and optic neuropathy is the orbital swelling leading to mechanical restriction of ocular muscles and compression of optic nerve, one expects proptosis rather than ptosis in TAO. We describe a case of a young adult woman who presented with acute onset restriction of movement along with partial ptosis and severe diminution of vision in left eye. The MRI of orbit revealed significant swelling of recti along with signal alteration consistent with TAO. The radio-isotope thyroid scan revealed thyroiditis, and thyroid peroxidase (TPO) antibody was significantly high; hence, the diagnosis of Hashimoto thyroiditis was considered. A course of intravenous methylprednisolone followed by oral steroid was administered, which produced marked improvement in vision and extraocular movement.
甲状腺相关眼病（TAO）是一种通常与格雷夫斯病相关的自限性自身免疫性疾病。其特征为眼痛、眼睑肿胀、结膜水肿、眼球突出和角膜病变。由于眼肌麻痹和视神经病变的机制是眼眶肿胀导致眼外肌机械性受限和视神经受压，因此在TAO中预期会出现眼球突出而非上睑下垂。我们描述了一例年轻成年女性病例，该患者表现为急性起病的眼球运动受限，同时伴有左眼部分上睑下垂和严重视力下降。眼眶MRI显示眼外直肌明显肿胀，信号改变符合TAO。放射性核素甲状腺扫描显示甲状腺炎，甲状腺过氧化物酶（TPO）抗体显著升高；因此，考虑诊断为桥本甲状腺炎。给予静脉注射甲泼尼龙，随后口服类固醇治疗，视力和眼外肌运动有显著改善。
