A study on relationship between severity of diabetic retinopathy and subclinical hypothyroidism

Background: Subclinical hypothyroidism (SCH) is defined as an asymptomatic condition characterized by normal serum levels of free thyroxine and elevated serum concentration of thyrotropin (>4.0µIU/ml). Association between diabetic retinopathy and SCH is unclear. Aim was to study the relationship between severity of diabetic retinopathy and SCH in patients of diabetic retinopathy with type 2 diabetes mellitus.Methods: 120 patients of diabetic retinopathy with known type 2 diabetes mellitus were taken and categorized them according to severity of diabetic retinopathy as per ETDRS classification. Serum thyrotropin (TSH) and free thyroxine (FT4) concentration were measured in all 120 patients. Patients with normal TSH and FT4 values are euthyroid patients and those with normal FT4 but TSH value >4µIU/ml are considered as having subclinical hypothyroidism. Severity of diabetic retinopathy is compared between the euthyroid and subclinical hypothyroid group.Results: Out of the 120 patients included in the study, 72 (60%) were male and 48 (40%) were female. 97 patients (80.83%) were Euthyroid and 23 patients (19.17%) had subclinical hypothyroidism. It was observed that prevalence of more severe form of diabetic retinopathy (severe NPDR and PDR) was higher in SCH group as compared to euthyroid group. Severity of diabetic retinopathy was compared with serum TSH level and it was seen that severity of diabetic retinopathy significantly increases with increase in serum TSH value.Conclusions: Patients with SCH had more severe form of diabetic retinopathy as compared to patients with euthyroidism. Severity of diabetic retinopathy significantly increases with increase in serum TSH value

Thyroid ophthalmopathy in an adolescent girl: a case report

A 14 year old girl presented with protrusion of both the eyes for duration of 3 months and pain, redness and watering of right eye for 20 days. On examination, she was thin built, poorly nourished and the thyroid gland was found to be enlarged. Both eyes were proptosed and there was incapability of complete closure of the eyelids on both sides. On right eye, conjunctiva was congested and there was a corneal lesion seen inferomedially with an epithelial defect. CT scan of the orbit revealed picture of thyroid ophthalmopathy. Thyroid profile revealed picture suggestive of hyperthyroidism and anti-thyroid peroxidase antibody was found to be very high. She was diagnosed as a case of thyroid ophthalmopathy both eyes with exposure keratitis right eye. She was treated with anti-thyroid medication along with conservative treatment for ocular symptoms and lateral tarsorrhaphy of right eye for exposure keratopathy. Pulse steroid therapy was started and subsequent follow up showed resolution of the signs