THYROID ASSOCIATED OPHTHALMOPATHY IN A 63-YEAR-OLD FEMALE WITH HASHIMOTO'S THYROIDITIS

Abstract

CASE
Thyroid-associated ophthalmopathy (TAO) affects extraocular muscles and orbital connective tissue. Generally associated with Graves' disease with positive TRAb, and Hashimoto's disease as well. Although usually mild, severe forms of Hashimoto TAO may need serious treatment.

A 63-year-old Indonesian female came with a blurred, bulging, and double vision of the right eye 7 months prior accompanied by a prominent sign of hypothyroidism. Physical examination showed proptosis, swollen eyelid, and conjunctival injection of the right eye. The point Clinical Activity Score (CAS) was 5. Laboratory results showed high TSH, low FT4, TRAb of 9.74 IU/L, and antiTPO of 62.47 IU/mL. Thyroid sonography revealed a right lobe hypoechoic nodule. Thyroid scan revealed cold nodule and FNAB showed benign struma adenomatosa. CT scan of the orbits showed bilateral proptosis with general muscle thickening. Hashimoto's thyroiditis and moderate-severe active TAO were established and treated with levothyroxine replacement, 4 cycles of high-dose steroid injection, and artificial tear drops. We reported a rare case of severe TAO with Hashimoto's thyroiditis who needed steroid pulse therapy.