Endocrine Abstracts

Apraxia of lid opening is defined as non-paralytic motor abnormality characterized by difficulty in lid opening after lid closure.

A 10-year-old presented to the ophthalmologist with history delayed opening the right eye after blinking. There was slight delay in opening of right eye after a blink during examination. There was no lid retraction. Visual acuity was normal in both eyes. Initial work up showed normal full blood count, urea and electrolytes and coeliac screen. Acetylcholine receptor antibodies were negative. The antinuclear antibodies titre was positive. While she was under regular review by ophthalmologists, she presented 18 months later to the children assessment unit with a diffuse painless neck swelling and tiredness. She had a diffuse non tender neck swelling with no palpable cervical lymph nodes. The rest of her clinical examination was normal. Thyroid function test done on clinical suspicion of hypothyroidism showed thyroid stimulating hormone was 144, T3 4.3, T4 4.7; thyroid peroxidase antibody was markedly raised at 1400. Coeliac screen, full blood count, urea and electrolytes are normal. She was started on thyroxine 50 micrograms once daily. Her thyroid function and goitre size and energy improved remarkably following administration of Thyroxine. The apraxia of the eyelid improved within four months of thyroxine therapy. She was reviewed by ophthalmologists nine months after starting thyroxine. She was found to be asymptomatic and discharged from their care.

There is lack of evidence in literature regarding an association between apraxia of lid opening and hypothyroidism. More research studies is needed to understand the association between these two conditions.