Endocrine Abstracts

Introduction: Thyroid ophthalmopathy occurs generally due to Graves’ disease. Only a few cases were reported about ophthalmopathy in the years following a thyroidectomy and RAI therapy or metastatic papillary thyroid cancer.

Case: A forty-six-year-old female patient was operated on for the fine needle aspiration biopsy (FNAB) result of a suspicious follicular neoplasia. A pathology examination showed a papillary microcarcinoma and Hashimoto thyroiditis. Her serum thyroglobulin level was < 0.2 ng/ml with the 175 mcg/day l-thyroxin replacement. At 24 months postoperatively, she had noticed prominence of her eyes, especially the left. The patient was given an eye examination which revealed bilateral exophthalmus, the patient had a bilateral eyelid retraction. Measurements by Hertel exophthalmometry were 20 mm in the right eye and 22 mm in the left. Her Clinical Activity Score was 2. Orbital CT scans showed a bilateral enlargement of the inferior, medial and superior rectus at the upper limit of normal and did not exceed 5 mm in thickness. Both of the central parts of the bulbus oculi muscles were located in the anterior of the interzygomatic line (exophthalmus). Her TSH receptor antibody was 9.46 U/l (in the normal range (0-14 U/l)), anti-TPO and anti-Tg antibodies were high as in the preoperative period (304.5/ml and 134.4 U/ml, respectively). Low levels of focal uptake by the two foci of residual thyroid tissue was detected at the thyroid scintigraphy. Levothyroxine dosage was adjusted according to the TSH values which should be near 0.5 mIU/l. The patient’s eye symptoms resolved completely approximately 6 months after.

Discussion: It should be kept in mind that, during follow-up of thyroidectomised patients with papillary thyroid cancer, ophthalmopathy may be developed, even if not given radioiodine or negative for usual autoantibodies.