Introduction: The ocular symptoms may be the first manifestation in an endocrine disorder of thyroid. The ocular manifestations are frequent in hyperthyroid Graves disease but rarely associated with Hashimotos disease, thyroid carcinomas and euthyroid states. Euthyroid patients with TAO, eventually develop subtle or overt fluctuations in thyroid function.

Aim 1. The various ocular manifestatons of thyroid disorders were examined and the relationship of Graves exophthalmos to serum T3,T4 was studied.

Materials and Methods: A prospective study of 50 patients with TAO above 18 years were done over a period of 18 months with detailed ocular workup including measurement of proptosis with Hertels exophthalmometer. Routine investigations and thyroid function test were done. Stastical analysis was done using SPSS version 11. Clinical profile is presented in %. Association of the different grades of ophthalmopathy with T3T4 levels was analysed using student t- test. .

Results: The most common ocular manifestation was lid retraction i.e in 35 (70%) cases. This was closely followed by proptosis i.e 33 (66%) cases. Ocular myopathy occurred in 22(44%) cases. The most common ocular symptom was grittiness and burning sensation.(48%). 3 (6%)cases had optic nerve involvement. The

mean levels of serum T3(p=0.605) and T4(p=0.548) were not significantly different in different degrees of exophthalmos.

Conclusion: TAO is a common ocular entity in a patient who may present to ophthalmologist in a referral centre. Our role lies both in diagnosing the ocular malady and treating it as well as directing the patient for evaluation and treatment of systemic manifestations of the disease at the earliest.

Absence of definite association between T3,T4 levels and exophthalmos and its occurrence even in  hypothyroid states supports immunological pathogenesis. Lab investigations are helpful to diagnose and monitor treatment aspects but newer investigative modalities are yet to be devised as definite markers of  TAO.

Keywords: thyroid ophthalmopathy, exophthalmos, graves.

1. Mornex R,Fournier G,Berthezene F.Modern Probl Ophthalmol 1975;14:426
2. Punita Kumari Sodhi, V P. Gupta, Ravindra M. Pandey Orbit2001,20(1): 1-9.
3. Thyroid eye disease a comprehensive review medical bulletin Vol15 No 10 Oct 2010.
4. Rajat maheswari,Ezekiel weis Thyroid associated orbitopathy IJO 2012 march-april;60(2):87-93
5. Bellur S Prabhakar et al. Current perspectives on the pathogenesis of graves disease and ophthalmopathy Endocrine review 2003 Dec;24(6):802-35.
6. Esra sahli,Kaan gundaaz. Thyroid associated ophthalmopathy Turk journal ophthalmol 2017;47 (2):94-105.
7. GB bartley et al.The epidemiological characteristics and clinical course of ophthalmopathy associatedwith autoim-mune thyroid disease in Olmsted county, Minnesota.
8. Naik MN, Goldberg 17.Naik VM RA, et al. Immunopathogenesis of thyroid eye disease: emerging paradigms. Surv Ophthalmol. 2010;55:215-26.
9. Andy C.O Chang. Thyroid associated ophthalmopathy: a neuroophthalmologist perspective Hong Kong J ophthalmology 2011 vol 15 ,no:1
10. Jesus Barrio-Barrio et al. Graves ophthalmopathy: VISA vs EUGOGO classification Hindawi Journal of ophthalmology vol 2015 article ID 249125
11. Maarten ph.mourits et al .Clinical activity score as a guide in the management of patients with graves ophthalmopathy. clinical endocrinology (july 1997) 47(1):9-12.
12. Barley GB,clinical features of Graves ophthalmopathy in an incidence cohort 1996 Am J Ophthalmol Mar;121(3):284-90.
13. Prof Frank Gallard et al .Thyroid associated orbitopathy radiopaedia
14. I dodds et al. Use of high resolution MRI of optic nerve in graves ophthalmopathy. British Journal of Radiology 82(2009)541-544.
15. Leon Das.H Dundas .The evolving role of selenium in treatment of Graves disease and ophthalmopathy. Journal of thyroid research vol 2012 ID 9736161
16. Mario salvi,Guia vannuchi,Beck Peccoz. Rituximab for the treatment of graves ophthalmopathy touch endocrinology. European endocrinology 2011;7(2):108-14

Dr Ambily S

Address: House no.9A, Sai Jyothy, Bhagat Singh Nagar, Nalanchira, Trivandrum

Ph no: 9846609689, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.