Euthyroid & Hypothyroid Ophthalmopathy:a Retrospective Observational Study in a Tertiary Care Centre in North India

Background: TAO is classically associated with hyperthyroidism, however it is now being increasingly recognized in euthyroid and hypothyroid individuals. Khoo et al, reported that the prevalence of euthyroid TAO and hypothyroid TAO was 0.7% and 0.2% respectively among Asian patients with TAO. Materials: We collected all cases of TAO, defined as proptosis, lid retraction, restriction of eye movements in presence of euthyroid or hypothyroid status who presented to our OPD. Results: Data of 15 non-hyperthyroid TAO patients was collected. The mean age of presentation was 44.13 years. Female to male ratio was 1.14:1. Median duration of TAO was 12 month. 5 Patients (33%) had symptoms for <1 year, 6 patients (40 %) had between1 to 3 years, and 4 patients (27%) had >3 years. 80% (12) were hypothyroid and 20% (3) were euthyroid. 40% (6) had active eye disease (CAS >3 score). According to EUGOGO 2021, 9 patients had mild, 5 had moderate to severe and 1 had sight threatening TAO. Goitre was present in 3 patients (20%). Asymmetric eye involvement was present in 5 patients (33%). Anti-TPO antibody was positive in 70% patients and TSHRAb was positive in 87.5% patients who were tested. 7 patients underwent ultrasound thyroid, 3 had atrophic thyroid, 1 was normal and 3 had goitre. Of the 6 patients who had active eye disease 5 took steroid, 3 had received iv steroid and 2 received oral steroid with subsequent improvement in symptoms. Conclusion: Most of the non-hyperthyroid TAO patients had hypothyroidism, most patients had mild disease, asymmetric eye disease was more common than GO, and in whom we tested TRAB was positive in 87.5%, though using routine assay we couldn’t differentiate stimulatory vs inhibitory TSHR antibody.