Endocrine Abstracts

Thyroid-associated ophthalmopathy (TAO) is an inflammation of the extraocular muscles and periorbital connective tissue caused by autoantibodies against common antigens to both the thyroid and orbit. The release of antigens and induction of hypothyroidism caused by radioactive iodine (RAI) therapy may cause or exacerbate TAO. Radioactive iodine therapy has been associated with worsening TAO, particularly in smokers. A 57 years old female treated with radioactive iodine therapy (RIA) for right toxic thyroid adenoma who presented with symptoms of puffiness around the eyes, protrusion of both eyes, conjunctival oedema, ophthalmoplegia, double visions, and pain in the both eyes 12 months after RAI. Clinical assessment did confirm a feature of TAO, and clinical activity score was 5 out of 7. MRI Scan of the orbit shown a feature of TAO in both eyes. TSH is 0.3 miu/l, FT4 20 pmol/l, Thyroid stimulating antibodies were high at 64.7 (NR 1-1.8 U/l) and before RAI it was negative. She has no symptoms or clinically features of TAO before went for RAI therapy. She develops hypothyroidism 4 months following radioactive iodine therapy, and thyroid function test is stable in levothyroxine treatment for the last a few months with TSH 0.4 before she develops symptoms of TAO. No other risk health issues and she is non-smoker. She had treatment with intravenous methyl prednisolone infusion to control her symptoms and she had a response to the steroid therapy and she is a under regular review in our endocrine clinic.

Conclusion: Our case report highlights the importance of thinking out of the possible developing TAO in non-autoimmune hyperthyroidism and to our knowledge this is unusual association of TAO in patient with nodular thyroid disease treated with RAI.