Methods:
Case 1.- 60 year-old non-diabetic woman, bilateral glaucoma in treatment, recurrent media otitis and euthyroidism, with acute onset of painless diplopia and lid ptosis in the left eye. MRI of orbit showed increased size of the III right cranial pair and high levels of thyroid autoantibodies (Tab) anti-tiroglobulin (ATG) 115.1, anti-thyroid peroxidase (ATPO) 1751 U/mL. She started oral deflazacort 30 mg each 3 days. 60 days later, complete remission of eye symptoms correlated with lower auto-antibodies level (ATG 19 ATPO 117).
Case 2.- 10 year-old girl. At age 8, she had diplopia, lid ptosis and limitations of upper gaze in the left eye. The neurological study discarded ocular myasthenia; with thyroid goitier, and hypothyrodism, she started oral levothyroxin. At age 10, with normal IRM. Botulinic toxin was injected, without change. High levels of Tab were found, ATG 2723, ATPO 10.7. She started oral deflazacort 30 mg each 3 days, azathioprin 100 mg, daily. Actually, Tab levels are almost normal, but she remains with ocular alterations.
Case 3.- 56 year-old woman, Grave´s disease with exophtalmos in 1990, treated with I 131 and immunosupression, with good outcome; obesity, hypertension and bilateral glaucoma in treatment . She suddenly presented diplopia and IV pair paresia of the right eye. A year later, ATb were found slightly elevated, ATG 100 y ATPO 227; despite prednisone 50 mg, each 3 days and azathioprin 150 mg/daily treatment, a surgical procedure was required for relieve the ocular symptoms.
Results: We found only three cases previously reported with this type of eye thyroid disease. Is important to note that awareness of this atypical form of orbitopathy
Conclusions:
Early recognition facilitates successful treatment (Case 1) or persistent disease when diagnosis is delayed (Cases 2 and 3).