Po478 Exophthalmos In Hypothyroid Patient

María Inmaculada López Leiva1, José Ignacio Valero Roldán1, María Eugenia Reyes García1, María Pino Salinas Martín1 e Iván Villar Mena1
1Emergency Department, Malaga Regional University Hospital, Málaga,Spain
Case Report 24 year-old patient with no known drug allergies, personal medical history of hypothyroidism treated with levothyroxine 75 mcg daily. Go to the ER for palpitations feeling associated with generalized anxiety as reported for hours from 1 month and exophthalmoses and progressive half ago. Also referred weight loss of about 14 kgs in 1 ¡ months. Physical Exploration: Conscious, oriented and cooperative, good general, well moisturised and infused, eupnoeic state. Eyes: bilateral visual acuity preserved; doubtful Marcus Gunn sign in izdo eye; evident exophthalmoses of the left eye, eye movements preserved, painless and unrestricted; mild hyperaemia left eye Fundus unaltered Cardiac auscultation: rhythm and steady beat, without murmurs or rubs to 140 beats per minute. Complementary tests: Chest radiograph unaltered. Electrocardiogram: sinus tachycardia at 130 beats per minute without repolarisation abnormalities or signs of cardiac ischaemia. Cranial CT scan: bilateral optic nerve edema in small claims right to left. Diagnosis: Exophthalmos. Autoimmune thyroid, Graves’ disease. Evolution; After titration Ophthalmology, performing head CT to rule decides compressive orbital injury being normal. After completion of the same contact Neurology reported it as bilateral optic nerve edema in small claims right to left of probable cause thyroid. Is derived to Internal Medicine Consultations where analytical tests are requested to demonstrate thyroid profile overactive thyroid and determination of thyroid antibodies are positive hormones. Besides NMR orbits with normal outcome and thyroid ultrasound showing no alterations not requested. After 2 months of ant thyroid therapy the exophthalmoses and analytical controls improved, so the antithyroid treatment is reduced Conclusions: Rare is the presence of exophthalmoses in patients with under-active thyroid, but it is a manifestation or symptom of an autoimmune disease (Graves’ disease) and are related to the presence of thyroid antibodies, mostly present in hyperthyroidism but not exclusive to it.
Exophthalmos; Graves’ disease; autoimmune thyroid; hypothyroid;