Thyroid-associated orbitopathy in patients with Hashimoto's thyroiditis: a case report

Area of Science:

• Ophthalmology
• Endocrinology
• Immunology

Background:

• Thyroid-associated orbitopathy (TAO) is an autoimmune condition affecting eye tissues, often linked to Graves' disease.
• TAO can cause exophthalmos, motility issues, and optic nerve pressure due to extraocular tissue swelling.
• While typically associated with Graves' disease, TAO occurs in only 5% of Hashimoto's disease cases.

Observation:

• A patient presented with active TAO and hypothyroidism secondary to Hashimoto's disease.
• Exclusion of other exophthalmos causes (tumors, vascular issues) was confirmed through various diagnostic tests.
• Elevated thyroid antibodies (antithyroglobulin, anti-thyroid peroxidase) and thyrotropin levels indicated an active autoimmune thyroid process.

Findings:

• Diagnostic workup confirmed Hashimoto's disease and active thyroid-associated orbitopathy.
• Coexistence of pernicious anemia, another autoimmune disorder, was identified.
• Treatment with methylprednisolone pulse therapy and levothyroxine led to remission of ophthalmic symptoms and achieved euthyroidism.

Implications:

• This case underscores the rare co-occurrence of thyroid orbitopathy and Hashimoto's disease.
• Early diagnosis and comprehensive management of autoimmune thyroid disorders are crucial for preventing severe complications.
• Recognizing and treating associated autoimmune conditions like pernicious anemia is vital for holistic patient care.