Thyroid-associated orbitopathy is a set of ophthalmic symptoms resulting from an autoimmune process in which the swelling of extraocular tissues leads to exophthalmos either caused by hypersecretion and accumulation of glycosaminoglycans in the orbit fibroblasts or being the result of inflammatory processes in the oculomotor. These changes cause eyeball motility disturbances, keratopathy, and the pressure on the optical nerve. Thyroid-associated orbitopathy accompanies Graves' disease in most cases, whereas the Hashimoto's disease in only 5%. In the present case, other reasons for the exophthalmos such as tumors of the orbit and sinuses, intracranial tumors, aneurysms and vascular fistulas and orbit tissue inflammation of different etiology were excluded. Additional examinations showed that thyrotropin level was 26 µIU/ml (normal range 0.27-4.0), antithyroglobulin antibody level was 1763 IU/ml (normal range 0-115), antithyrotropin antibody level was 4.93 IU/l (normal range 0-1), and anti-thyroid peroxidase antibody level was 1609 IU/ml (normal range 0-35). An ultrasound examination showed a thyroid gland of 9.8 ml volume. A cytological presentation obtained by thin-needle aspiration biopsy demonstrated inflammatory infiltration of lymphocytes, indicating an autoimmune process. The iodine uptake after 24 hours was 9%. The active form of orbitopathy was diagnosed in the patient with hypothyreosis in the course of Hashimoto's disease. Moreover, the coexistence of another autoimmune disease, pernicious anemia was diagnosed. The administration of the methylprednisolone pulse therapy and levothyroxine caused remission of ophthalmic symptoms, and euthyreosis was obtained. Our report presents a rare coexistence of thyroid orbitopathy and Hashimoto's disease.
BackgroundThyroid disorders are very common in adults. Despite advances in conservative management, surgery remains a treatment modality of choice in many cases. The mortality and morbidity of thyroidectomy are low, but long-term postoperative hypoparathyroidism (HPT) remains a prominent complication of the procedure.The aim of this study was to assess the incidence of permanent HPT and identify the risk factors for this complication in a cohort of post-thyroidectomy patients followed at a District Endocrine Clinic.Material/MethodsThis was a retrospective analysis of 401 patients followed up at a Regional/District Endocrine Clinic, who had undergone thyroid surgery in the years 1993–2011. The percentage of patients with permanent (>12 months) HPT was the primary endpoint of the study. The statistically analyzed data of patients with permanent HPT versus the remaining patients free from postoperative complications included their demographic data, indications for surgical treatment of their thyroid disorder, and extent of the thyroid resection. The risk factors for postoperative hypoparathyroidism were assessed using logistic regression analysis.ResultsPermanent HPT following surgery on the thyroid gland occurred in 8.5% of the patients. It was more frequent following total thyroidectomy (20.2%) than near-total thyroidectomy (6.7%) or subtotal thyroidectomy (4.2%); p<0.0001. A multivariate statistical regression analysis demonstrated that primary total thyroidectomy was a significant risk factor for permanent HPT (OR 6.5; 95% CI: 2.9–14.4; p<0.0001).ConclusionsTotal thyroidectomy was associated with increased prevalence of permanent hypoparathyroidism when compared to less extensive thyroid resection modes in patients with benign thyroid diseases.
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