title: Thyroid associated orbitopathy with ocular myasthenia in primary hypothyroidism: Keep those eyes open.
abstract: Thyroid associated orbitopathy, although seen most commonly with thyrotoxicosis, is also known to occur in primary hypothyroidism. Myasthenia gravis is an autoimmune condition with an established association with autoimmune thyroid disease. We report the case of a patient who presented with recent onset unilateral ptosis that was fatigable with a history of proptosis since a year. On examination, she had a goiter, bilateral proptosis, restriction of upward gaze and adduction both eyes and normal pupils. Investigations revealed primary hypothyroidism with anti-thyroid peroxidase positive and anti-acetylcholine receptor antibody positive. Computerized tomography orbit showed thickening of medial and inferior rectus characteristic of thyroid orbitopathy. A diagnosis of primary hypothyroidism with thyroid orbitopathy with ocular myasthenia gravis was made. Patient is on Levothyroxine and anticholinesterase medications and is on follow-up. We present this case to highlight that the presence of ptosis in a patient with thyroid orbitopathy should alert the clinician to the possible coexistence of myasthenia gravis.
authors.affiliation: Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Chitra
authors.initials: C
authors.lastname: Selvan
authors.affiliation: Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Deep
authors.initials: D
authors.lastname: Dutta
authors.affiliation: Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Indira
authors.initials: I
authors.lastname: Maisnam
authors.affiliation: Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Anubhav
authors.initials: A
authors.lastname: Thukral
authors.affiliation: Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: P P
authors.initials: PP
authors.lastname: Chakraborthy
authors.affiliation: Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Ajitesh
authors.initials: A
authors.lastname: Roy
authors.affiliation: Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Arora
authors.affiliation: Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Soumik
authors.initials: S
authors.lastname: Dutta
authors.affiliation: Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Arjun
authors.initials: A
authors.lastname: Baidya
authors.affiliation: Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Sujoy
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Satinath
authors.initials: S
authors.lastname: Mukhopadhyay
authors.affiliation: Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Subhankar
authors.initials: S
authors.lastname: Chowdhury
keywords: Grave's ophthalmopathy; hypothyroidism; myasthenia