Frequency of Thyrotoxicosis in Patients Presenting with Unilateral Proptosis in District Headquarters Teaching Hospital D.I.Khan: Thyrotoxicosis with Unilateral Proptosis in Patients

Salman Khan; Naseeb ur Rehman; Abdur Rehman; Muhammad Zubair; Rida Naz

doi:10.54393/pjhs.v5i06.1673

Authors

Salman Khan Medical Unit, District Headquarters Teaching Hospital, Gomal Medical College, Dera Ismail Khan, Pakistan
Naseeb ur Rehman Khalifa Gul Nawaz Teaching Hospital, Bannu, Pakistan
Abdur Rehman Medical Unit, District Headquarters Teaching Hospital, Gomal Medical College, Dera Ismail Khan, Pakistan
Muhammad Zubair Medical Unit, District Headquarters Teaching Hospital, Gomal Medical College, Dera Ismail Khan, Pakistan
Rida Naz Regional Blood Centre, Dera Ismail Khan, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i06.1673

Keywords:

Unilateral Proptosis, Thyrotoxicosis, Retrobulbar Tumor, Cavernous Sinus Thrombosis, Idiopathic Proptosis

Abstract

Thyrotoxicosis is a medical disorder marked by retraction of the eyelids, resulting in a wide-eyed or gazing appearance. This syndrome can occur in patients with any form of hyperthyroidism as a result of increased activity of the sympathetic nervous system. Objectives: To investigate the prevalence of thyrotoxicosis and factors contributing to unilateral proptosis, with a specific focus on early diagnosis and prompt treatment. Methods: A cross-sectional study was conducted from January 2023 to January 2024 and categorical variables were presented with the frequency and percentage. The study had a total of 62 patients who exhibited unilateral proptosis. The clinical examinations involved a comprehensive collection of medical history, examination of eyes, analysis of blood samples, evaluation of thyroid function, and utilization of advanced imaging techniques. The associations between thyrotoxicosis and demographic variables were evaluated using chi-square tests. Data were entered and analyzed on SPSS version 26. Results: The mean age of participants was 27.84 ± 6.8 years and female comprised 54.8% of the total. It was observed that female had a greater incidence rate (73.5%) compared to male (53.6%) (p>0.05). Additional findings included retrobulbar tumors (16.1%), cavernous sinus thrombosis (12.9%), and idiopathic proptosis (6.5%). The prevalence of thyrotoxicosis was highest among individuals aged 15-30 (p<0.05). The most common symptom linked with thyrotoxicosis was diplopia (33.9%) (p<0.05). Conclusions: Thyrotoxicosis has a major role in causing unilateral proptosis, especially in female and younger persons. Being female and experiencing pain may serve as predictors for thyrotoxicosis.

References

Zafar T, Perveen S, Khan N, Ahmed T. Frequency of Thyrotoxicosis in Patient with One Sided Exophthalmos. RADS Journal of Pharmacy and Pharmaceutical Sciences. 2020 Nov; 8(2): 81-4. doi: 10.37962/jpps.v8i2.373. DOI: https://doi.org/10.37962/jpps.v8i2.373

Ackuaku-Dogbe EM, Akpalu J, Abaidoo B. Epidemiology and clinical features of thyroid-associated orbitopathy in Accra. Middle East African Journal of Ophthalmology. 2017 Oct; 24(4): 183-9. doi: 10.4103/meajo.MEAJO_91_17. DOI: https://doi.org/10.4103/meajo.MEAJO_91_17

Delyfer MN, Gaucher D, Govare M, Cougnard-Grégoire A, Korobelnik JF, Ajana S et al. Adapted surgical procedure for Argus II retinal implantation: feasibility, safety, efficiency, and postoperative anatomic findings. Ophthalmology Retina. 2018 Apr; 2(4): 276-87. doi: 10.1016/j.oret.2017.08.010. DOI: https://doi.org/10.1016/j.oret.2017.08.010

Gharib S, Moazezi Z, Bayani MA. Prevalence and severity of ocular involvement in Graves’ disease according to sex and age: A clinical study from Babol, Iran. Caspian Journal of Internal Medicine. 2018; 9(2): 178.

Tanda ML, Piantanida E, Liparulo L, Veronesi G, Lai A, Sassi L et al. Prevalence and natural history of Graves' orbitopathy in a large series of patients with newly diagnosed graves' hyperthyroidism seen at a single center. The Journal of Clinical Endocrinology & Metabolism. 2013 Apr; 98(4): 1443-9. doi: 10.1210/jc.2012-3873. DOI: https://doi.org/10.1210/jc.2012-3873

Teja N, Reddy M, Vanama A. An etiological analysis of proptosis. International Journal of Research in Medical Sciences. 2017 Jan; 3(10): 2584-8. doi: 10.18203/2320-6012.ijrms20150795. DOI: https://doi.org/10.18203/2320-6012.ijrms20150795

Zahir SI, Khan MU, Ahmad M, Hussain I, Hamayun J. Etiological Pattern, Clinical Presentation and Outcome of Patients with Proptosis in a Tertiary Care Hospital. Pakistan Armed Forces Medical Journal. 2022; 72(6): 2113-16. doi: 10.51253/pafmj.v72i6.6097. DOI: https://doi.org/10.51253/pafmj.v72i6.6097

Agha A, Pangy T, Ajayi O, Solomon AL. Septic cavernous sinus thrombosis; a rare cause of unilateral exophthalmos. The Ulster Medical Journal. 2020 Sep; 89(2): 131.

Paul S, Tost F, Hübner BC. Unilateral Exophthalmos. Deutsches Ärzteblatt International. 2022 Sep; 119(37): 618. doi: 10.3238/arztebl.m2022.0128. DOI: https://doi.org/10.3238/arztebl.m2022.0128

Si AS, Benoumechiara I, Fedala NS. When unilateral exophthalmos is the only manifestation of graves. InEndocrine Abstracts 2022 May; 81. doi: 10.1530/endoabs.81.EP1135. DOI: https://doi.org/10.1530/endoabs.81.EP1135

Keenswijk W, Degraeuwe E, Hoorens A, Dorpe JV, Vande Walle J. A case of Graves’ disease associated with membranoproliferative glomerulonephritis and leukocytoclastic vasculitis. Journal of Pediatric Endocrinology and Metabolism. 2018 Oct; 31(10): 1165-8. doi: 10.1515/jpem-2018-0186. DOI: https://doi.org/10.1515/jpem-2018-0186

Fuchs AA, Walker KE, Adkins PR, Donnelly KS, Giuliano EA. Diagnosis and surgical management of a retrobulbar abscess causing unilateral exophthalmos in a Boer goat. Veterinary Ophthalmology. 2021 Nov; 24(6): 639-44. doi: 10.1111/vop.12906. DOI: https://doi.org/10.1111/vop.12906

Muammar AR and khan AA. SAT-490 A Case of Unilateral Exophthalmos Due to Thyroid Orbitopathy and Its Association with Chronic Kidney Disease. Journal of the Endocrine Society. 2020 Apr; 4(1): 490. doi: 10.1210/jendso/bvaa046.1403. DOI: https://doi.org/10.1210/jendso/bvaa046.1403

Bouktib Y, Abidine E, Boutakioute B, El Hajjami A, Amenzouy F, Idrissi MO et al. Intraorbital Cavernous Hemangioma: Rare Cause of Exophthalmos. Scholars Journal of Medical Case Reports. 2023 Apr; 4: 707-10. doi: 10.36347/sjmcr.2023.v11i04.072. DOI: https://doi.org/10.36347/sjmcr.2023.v11i04.072

Takeda Y, Suzuki H, Hosono K, Hikoya A, Komori M, Inagaki R et al. Exophthalmos associated with chronic progressive external ophthalmoplegia. Japanese Journal of Ophthalmology. 2022 May; 66(3): 314-9. doi: 10.1007/s10384-022-00920-5. DOI: https://doi.org/10.1007/s10384-022-00920-5

Tauber J, Polla DJ, Park S. Exophthalmos in Kearns-Sayre syndrome. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2019 Oct; 23(5): 295-7. doi: 10.1016/j.jaapos.2019.05.005. DOI: https://doi.org/10.1016/j.jaapos.2019.05.005

Chehade LK, Rajak SN, Selva D. Proptosis secondary to third nerve palsy. Clinical & Experimental Ophthalmology. 2017 Dec; 45(9). doi: 10.1111/ceo.12987. DOI: https://doi.org/10.1111/ceo.12987

Bhattarai HB, Thapaliya I, Dhungana S, Singh PB, Bhattarai M, Pokhrel B et al. Unilateral proptosis in a patient with thyroid eye disease: A case report. SAGE Open Medical Case Reports. 2023 Jul; 11: 2050313X231190669. doi: 10.1177/2050313X231190669. DOI: https://doi.org/10.1177/2050313X231190669

Zarei S, Vo P, Sam C, Crow RW, Stout C, Al-Khoury L. Acute bilateral blindness in the setting of sudden onset of bilateral proptosis and ophthalmoplegia: a case report with literature review. Neurology: Clinical Practice. 2021 Oct; 11(5): e706-13. doi: 10.1212/CPJ.0000000000001090. DOI: https://doi.org/10.1212/CPJ.0000000000001090

Khan AA, Mahmoud Muammar AR, Kamal I. A case of unilateral exophthalmos due to thyroid orbitopathy in a clinically euthyroid patient. World Journal of Advanced Research and Reviews. 2019; 9: 1-3. doi: 10.31871/WJRR.9.6.6. DOI: https://doi.org/10.31871/WJRR.9.6.6

Bojikian KD and Francis CE. Thyroid eye disease and myasthenia gravis. International Ophthalmology Clinics. 2019 Jul; 59(3): 113-24. doi: 10.1097/IIO.0000000000000277. DOI: https://doi.org/10.1097/IIO.0000000000000277

Yang J, Hu X, Li Q, Huang RL. Botulinum Toxin Type A Injection for Correction of Upper Eyelid Retraction in Thyroid-Associated Ophthalmopathy. Journal of Craniofacial Surgery. 2023 Jul; 34(5): e485-8. doi: 10.1097/SCS.0000000000009347. DOI: https://doi.org/10.1097/SCS.0000000000009347

Segni M. Disorders of the Thyroid Gland in Infancy, Childhood and Adolescence. [Updated 2017 Mar 18]. South Dartmouth (MA): Endotext [Internet]; 2000.

Blick C, Nguyen M, Jialal I. Thyrotoxicosis. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.

Men CJ, Kossler AL, Wester ST. Updates on the understanding and management of thyroid eye disease. Therapeutic advances in ophthalmology. 2021 Jun; 13: 25158414211027760. doi: 10.1177/25158414211027760. DOI: https://doi.org/10.1177/25158414211027760

Stephen MA, Ahuja S, Jayasri P, Harigaravelu PJ. Peripheral primitive neuroectodermal tumor of the orbit in Graves' ophthalmopathy–A rare presentation. Saudi Journal of Ophthalmology. 2023 Jan; 37(1): 69-71. doi: 10.4103/sjopt.sjopt_143_21. DOI: https://doi.org/10.4103/sjopt.sjopt_143_21

Macovei ML and Azis Ű. A case report of a patient with severe thyroid eye disease. Romanian Journal of Ophthalmology. 2022 Apr; 66(2): 153. doi: 10.22336/rjo.2022.30. DOI: https://doi.org/10.22336/rjo.2022.30

Ahmed I and Al Ibrahimi S. Abstract# 1318463: Severe Unilateral Exophthalmos as Early Presentation of Hashimoto’s Thyroiditis. Endocrine Practice. 2022 Dec; 28(12): S64. doi: 10.1016/j.eprac.2022.10.135. DOI: https://doi.org/10.1016/j.eprac.2022.10.135

Weng CY. Retrobulbar Hematoma in a Patient with Thyroid Eye Disease. Journal of Emergencies, Trauma, and Shock. 2022 Oct; 15(4): 188-9. doi: 10.4103/jets.jets_164_21. DOI: https://doi.org/10.4103/jets.jets_164_21

Shahid MA, Ashraf MA, Sharma S. Physiology, Thyroid Hormone. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500006/