Selvan Chitra, Dutta Deep, Maisnam Indira, Thukral Anubhav, Chakraborthy P P, Roy Ajitesh, Arora Rakesh, Dutta Soumik, Baidya Arjun, Ghosh Sujoy, Mukhopadhyay Satinath, Chowdhury Subhankar
Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
Indian J Endocrinol Metab. 2013 Dec;17(Suppl 3):S657-9. doi: 10.4103/2230-8210.123559.
Thyroid associated orbitopathy, although seen most commonly with thyrotoxicosis, is also known to occur in primary hypothyroidism. Myasthenia gravis is an autoimmune condition with an established association with autoimmune thyroid disease. We report the case of a patient who presented with recent onset unilateral ptosis that was fatigable with a history of proptosis since a year. On examination, she had a goiter, bilateral proptosis, restriction of upward gaze and adduction both eyes and normal pupils. Investigations revealed primary hypothyroidism with anti-thyroid peroxidase positive and anti-acetylcholine receptor antibody positive. Computerized tomography orbit showed thickening of medial and inferior rectus characteristic of thyroid orbitopathy. A diagnosis of primary hypothyroidism with thyroid orbitopathy with ocular myasthenia gravis was made. Patient is on Levothyroxine and anticholinesterase medications and is on follow-up. We present this case to highlight that the presence of ptosis in a patient with thyroid orbitopathy should alert the clinician to the possible coexistence of myasthenia gravis.
甲状腺相关性眼病虽然最常见于甲状腺毒症，但也可见于原发性甲状腺功能减退症。重症肌无力是一种自身免疫性疾病，与自身免疫性甲状腺疾病有明确关联。我们报告一例患者，该患者近期出现单侧上睑下垂，伴有疲劳感，且有一年的突眼病史。检查发现，她有甲状腺肿大、双侧突眼、双眼上视和内收受限以及瞳孔正常。检查显示原发性甲状腺功能减退症，抗甲状腺过氧化物酶阳性且抗乙酰胆碱受体抗体阳性。眼眶计算机断层扫描显示甲状腺眼病特征性的内直肌和下直肌增厚。诊断为原发性甲状腺功能减退症合并甲状腺眼病及眼肌型重症肌无力。患者正在服用左甲状腺素和抗胆碱酯酶药物，并在接受随访。我们展示此病例以强调，甲状腺眼病患者出现上睑下垂应提醒临床医生注意可能并存重症肌无力。
