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Diplopia in Autoimmune Thyroid Disease

Diplopia in Autoimmune Thyroid Disease Abstract Diplopia without obvious exophthalmos, caused by infiltrative endocrine ophthalmopathy, developed in 12 patients with clinical and laboratory confirmation of autoimmune thyroid disease. In eight patients, the diplopia alone prompted medical attention, which led to the diagnosis of autoimmune thyroid disease. A hypotropia secondary to restrictive tightening of the inferior rectus muscle, producing vertical diplopia, was the most common manifestation of the disorder. The ocular muscle imbalance in autoimmune thyroid disease is caused by mechanical orbital restriction of the extraocular muscle, not by an innervational defect. Evidence of orbital restriction of the eye muscles can establish the diagnosis, regardless of the patient's thyroid function. Back to top Article Information Reprint requests to Department of Ophthalmology, University of Wisconsin Center for Health Sciences, 600 Highland Ave, Madison, WI 53792 (Dr Appen). References 1. Graves RJ: Clinical lectures. London Med Surg J. 1835;7:516-525.Google Scholar 2. Werner SC: Euthyroid patients with early eye signs of Graves' disease. Am J Med. 1955;18:608-612. PubMedGoogle ScholarCrossref 3. Hall R, Kirkham K, Doniach D, et al: Ophthalmic Graves' disease. Lancet. 1970;1:375-378.Google ScholarCrossref 4. Grove AS Jr: Evaluation of exophthalmos. N Engl J Med. 1975;292:1005-1013. PubMedGoogle ScholarCrossref 5. Wyse EP, McConahey WM, Wooner LB, et al: Ophthalmopathy without hyperthyroidism in patients with histologic Hashimoto's thyroiditis. J Clin Endocrinol Metab. 1968;28:1623-1629. PubMedGoogle ScholarCrossref 6. Liddle GW, Heyssel RM, McKenzie JM: Graves' disease without hyperthyroidism. Am J Med. 1965;39:845-848.Google ScholarCrossref 7. Hyman BN, Johnson PC: Thyrotropin-releasing hormone (a test to diagnose Graves' ophthalmopathy). Trans Am Acad Ophthalmol Otol. 1975; 79:524-528. PubMedGoogle Scholar 8. Solomon DH, Chopra IJ, Chopra U, et al: Identification of subgroups of euthyroid Graves' ophthalmopathy. N Engl J Med. 1977;296:181-186. PubMedGoogle ScholarCrossref 9. Rosenberg IN: Euthyroid Graves' disease. N Engl J Med. 1977;296:223-225.Google ScholarCrossref 10. Teng CS, Yeo PPB: Ophthalmic Graves' disease: Natural history and detailed thyroid function studies. Br Med J. 1977;1:273-275. PubMedGoogle ScholarCrossref 11. Donaldson SS, Bagshaw MA, Kriss JP: Supervoltage orbital radiotherapy for Graves' ophthalmopathy. J Clin Endocrinol Metab. 1973;37:276-285. PubMedGoogle ScholarCrossref 12. Manor RS, Kurz 0, Lewitus Z: Intraocular pressure in endocrinological patients with exophthalmos. Ophthalmologica. 1974;168:241-252. PubMedGoogle ScholarCrossref 13. Metz HS: Saccadic velocity studies in patients with endocrine ocular disease. Am J Ophthalmol. 1977;84:695-699. PubMedGoogle ScholarCrossref 14. Hilal SK, Trokel SL: Computerized tomography of the orbit using thin sections. Semin Roentgenol. 1977;12:137-147. PubMedGoogle ScholarCrossref 15. Werner SC, Coleman DS, Franzen LA: Ultrasonographic evidence of a consistent orbital involvement in Graves' disease. N Engl J Med. 1974; 290:1447-1450. PubMedGoogle ScholarCrossref 16. Fisher CM: An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia, and areflexia). N Engl J Med. 1956; 255:57-65. PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340180056013
Publisher site
See Article on Publisher Site

Abstract

Abstract Diplopia without obvious exophthalmos, caused by infiltrative endocrine ophthalmopathy, developed in 12 patients with clinical and laboratory confirmation of autoimmune thyroid disease. In eight patients, the diplopia alone prompted medical attention, which led to the diagnosis of autoimmune thyroid disease. A hypotropia secondary to restrictive tightening of the inferior rectus muscle, producing vertical diplopia, was the most common manifestation of the disorder. The ocular muscle imbalance in autoimmune thyroid disease is caused by mechanical orbital restriction of the extraocular muscle, not by an innervational defect. Evidence of orbital restriction of the eye muscles can establish the diagnosis, regardless of the patient's thyroid function. Back to top Article Information Reprint requests to Department of Ophthalmology, University of Wisconsin Center for Health Sciences, 600 Highland Ave, Madison, WI 53792 (Dr Appen). References 1. Graves RJ: Clinical lectures. London Med Surg J. 1835;7:516-525.Google Scholar 2. Werner SC: Euthyroid patients with early eye signs of Graves' disease. Am J Med. 1955;18:608-612. PubMedGoogle ScholarCrossref 3. Hall R, Kirkham K, Doniach D, et al: Ophthalmic Graves' disease. Lancet. 1970;1:375-378.Google ScholarCrossref 4. Grove AS Jr: Evaluation of exophthalmos. N Engl J Med. 1975;292:1005-1013. PubMedGoogle ScholarCrossref 5. Wyse EP, McConahey WM, Wooner LB, et al: Ophthalmopathy without hyperthyroidism in patients with histologic Hashimoto's thyroiditis. J Clin Endocrinol Metab. 1968;28:1623-1629. PubMedGoogle ScholarCrossref 6. Liddle GW, Heyssel RM, McKenzie JM: Graves' disease without hyperthyroidism. Am J Med. 1965;39:845-848.Google ScholarCrossref 7. Hyman BN, Johnson PC: Thyrotropin-releasing hormone (a test to diagnose Graves' ophthalmopathy). Trans Am Acad Ophthalmol Otol. 1975; 79:524-528. PubMedGoogle Scholar 8. Solomon DH, Chopra IJ, Chopra U, et al: Identification of subgroups of euthyroid Graves' ophthalmopathy. N Engl J Med. 1977;296:181-186. PubMedGoogle ScholarCrossref 9. Rosenberg IN: Euthyroid Graves' disease. N Engl J Med. 1977;296:223-225.Google ScholarCrossref 10. Teng CS, Yeo PPB: Ophthalmic Graves' disease: Natural history and detailed thyroid function studies. Br Med J. 1977;1:273-275. PubMedGoogle ScholarCrossref 11. Donaldson SS, Bagshaw MA, Kriss JP: Supervoltage orbital radiotherapy for Graves' ophthalmopathy. J Clin Endocrinol Metab. 1973;37:276-285. PubMedGoogle ScholarCrossref 12. Manor RS, Kurz 0, Lewitus Z: Intraocular pressure in endocrinological patients with exophthalmos. Ophthalmologica. 1974;168:241-252. PubMedGoogle ScholarCrossref 13. Metz HS: Saccadic velocity studies in patients with endocrine ocular disease. Am J Ophthalmol. 1977;84:695-699. PubMedGoogle ScholarCrossref 14. Hilal SK, Trokel SL: Computerized tomography of the orbit using thin sections. Semin Roentgenol. 1977;12:137-147. PubMedGoogle ScholarCrossref 15. Werner SC, Coleman DS, Franzen LA: Ultrasonographic evidence of a consistent orbital involvement in Graves' disease. N Engl J Med. 1974; 290:1447-1450. PubMedGoogle ScholarCrossref 16. Fisher CM: An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia, and areflexia). N Engl J Med. 1956; 255:57-65. PubMedGoogle ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1982

Keywords: diplopia,thyroid disease, autoimmune,thyroid function tests,hypotropia,graves' ophthalmopathy,exophthalmos,muscle of orbit,inferior rectus muscle

References