Post thyroidectomy surprise!

Aims/Purpose: To report a patient who developed dysthyroid optic neuropathy post thyroidectomy

Methods: Patient who came to the Eye OPD with diminution of vision post thyroidectomy procedure was evaluated

Results: A 57-year-old female who had Grave's ophthalmopathy detected 8 months ago, vision 6/6 B/E came to the EYE OPD with sudden exacerbation of symptoms for the past 4 days. She had undergone total thyroidectomy 8 days ago. Her visual acuity was 6/24 both eyes and Color vision was impaired in the both the eyes, left eye more than right eye. On ocular examination there was upper lid retraction both the eyes with scleral show. There was fullness of B/E lower lids with lid lag B/E. EOM were mildly restricted in B/E and pupils were sluggishly reacting B/E, rest anterior segment: WNL. Patient was pharmacologically dilated for fundus examination and both eyes disc pallor was noted.

CECT Orbits was performed which showed significant enlargement and prominence of bilateral extraocular muscles, predominantly inferior and medial rectus (left eye > right). Vertical Barrett's Index of left eye > 60% suggestive of significant optic nerve impingement of left eye. Thyroid tests performed showed profound hypothyroidism with FT4 1.9 pg/ml, TSH: 41 microU/ml.

Euthyroid state was rapidly restored with thyroxine and T3 supplements and optic neuropathy was treated with oral steroids. Patient was kept on regular follow up and dysthyroid optic neuropathy improved significantly with restoration of normal visual acuity.

Conclusions: Dysthyroid optic neuropathy may be precipitated post thyroidectomy in patients developing hypothyroidism suggesting that euthyroid state must be maintained and prompt treatment with steroids of graves ophthalmopathy can restore normal visual acuity.