Infiltrative Ophthalmopathy and Primary Hypothyroidism

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Abstract
A 40-yr.-old white housewife presenting with infiltrative ophthalmopathy typical of Graves'' disease was found to be hypothyroid without previous history of hyperthyroidism. Examination of the right eye revealed exophthalmos and hypotropia. Restriction of forced upward duction of the right eye led to correction of adhesions involving the right inferior rectus and right inferior oblique muscles. Laboratory evaluation of her thyroid status clearly demonstrated hypothyroidism. However, the presence of LATS [long acting thyroid stimulator] was detected in the serum. The association of infiltrative ophthalmopathy and primary hypothyroidism was found not to be unique, verified by 46 similar cases in the English literature. The existence of infiltrative ophthalmopathy in hypothyroid as well as euthyroid patients with detectable serum LATS levels may represent relative degrees of impairment of thyroid reserve from pre-existing causes such as struma lymphomatosa.

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