Korean J Fam Med 2016; 37(3): 197-201  https://doi.org/10.4082/kjfm.2016.37.3.197
Optic Neuropathy in Thyroid Eye Disease: A Case Series
Nur Aqilah Salleh*, Wong Hon Seng, Hazlita Dato’ Mohd Isa
Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
Nur Aqilah Salleh Tel: +60-167762804, Fax: +60-391456673, E-mail: Aqilahthesisproject@yahoo.com
Received: January 14, 2016; Revised: February 4, 2016; Accepted: March 10, 2016; Published online: May 20, 2016.
© Korean Academy of Family Medicine. All rights reserved.

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Abstract
In patients with thyroid disease, ocular involvement or thyroid ophthalmopathy is common, irrespective of their thyroid status. A common feature of thyroid eye disease is eyelid retraction, which leads to a classical starry gaze (Kocher sign). Treatment with radioactive iodine (RAI) is a known therapy for hyperthyroidism. However, this treatment may lead to or worsen thyroid ophthalmopathy. We report a case series of two patients with thyrotoxicosis, who presented with an atypical and subtle occurrence of thyroid eye disease (TED) soon after RAI therapy. One of the patients was initially diagnosed and treated for dry eyes; however, over a period of time, the patient’s vision progressively deteriorated. Clinical and radiological investigations confirmed thyroid ophthalmopathy with low serum thyroid hormone levels. Both patients recovered well after immediate intensive intravenous steroid treatment. These cases highlight the importance of recognizing partial ptosis as one of the presenting signs of active TED among general practitioners and physicians.
Keywords: Radioactive Iodine; Proptosis; Ptosis; Thyroid Eye Disease; Relative Afferent Pupillary Defect


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