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Recurrent external ophthalmoparesis during hormonal therapy after thyroid ablation. Case report
F Ferracci1, F Conte, B Marini
1Divisione di Neurologia, Ospedale Civile di Belluno, Italy.
Italian Journal of Neurological Sciences
|August 1, 1997
Summary
Graves' disease treatment with thyroid hormone replacement therapy can cause temporary eye muscle dysfunction. Discontinuing and reintroducing levothyroxine or triiodothyronine in patients with Graves' disease can trigger or resolve external ophthalmoparesis.
Area of Science:
- Endocrinology
- Ophthalmology
Background:
- Graves' disease is an autoimmune disorder leading to hyperthyroidism.
- Total thyroid ablation is a treatment option for severe Graves' disease.
- Thyroid hormone replacement therapy is standard after ablation.
Observation:
- A patient developed left external ophthalmoparesis after starting levothyroxine therapy post-thyroid ablation.
- The ophthalmoparesis resolved upon drug discontinuation.
- Symptoms recurred with reintroduction of thyroid hormone replacement therapy (levothyroxine or triiodothyronine).
Findings:
- Thyroid hormone replacement therapy, specifically levothyroxine and triiodothyronine, may precipitate or exacerbate external ophthalmoparesis in some patients.
- The condition appears directly related to the presence of exogenous thyroid hormone.
Implications:
- This case highlights a potential adverse effect of thyroid hormone replacement therapy.
- Clinicians should consider thyroid hormone levels and potential ocular side effects in patients with Graves' disease undergoing treatment.
- Further investigation into the mechanism linking thyroid hormone replacement and ophthalmoparesis is warranted.