Systemic follicular lymphoma in a patient with a history of thyroid eye disease: a case report

AimsTo evaluate the natural course of upper eyelid retraction (UER) in patients with thyroid eye disease (TED) and factors affecting its course.MethodsRetrospective non-interventional cohort study in a single tertiary institution from March 2006 to March 2015 on patients with TED with (1) unilateral or bilateral UER within 6 months from initial presentation, and (2) no prior interventions nor surgical treatment for their UER. Main outcomes and measures were mean margin reflex distance 1 (MRD1) and factors associated with UER improvement.ResultsThere were a total of 61 patients and 81 eyes (41 unilateral and 20 bilateral UER). Mean age was 42.3±15.1 years. Mean MRD1 decreased from 6.1 mm at presentation to 4.8 mm at 12 months, and 4.4 mm at 24 months. The proportion of eyes with normalisation of lid height increased from 0% at presentation to 22.2% at 6 months, 37.0% at 12 months and 49.4% at 24 months. Mean time to normalisation of MRD1 was 18.0±12.4 months. A positive family history of TED was found to be associated with a 6.2 times lower likelihood of normalisation. Change in exophthalmometry, clinical activity score and thyroid-stimulating immunoglobulin were significantly correlated to change in MRD1 (p<0.05). There was no correlation between change in MRD1 and thyroid-stimulating hormone receptor antibodies.ConclusionAn improved knowledge of the natural history of UER in TED will allow us to better decide and evaluate the optimal management for such patients.

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Orbital radiotherapy for thyroid eye disease: case report with a review of the literature

BJR|case reports ◽

10.1259/bjrcr.20150385 ◽

2016 ◽

Vol 2 (2) ◽

pp. 20150385

Author(s):

Andrew Luu

Keyword(s):

Case Report ◽

Thyroid Eye Disease ◽

Eye Disease ◽

Review Of The Literature ◽

Orbital Radiotherapy ◽

Disease Case

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Follicular lymphoma in a patient with splenosis: a case report

Journal of International Medical Research ◽

10.1177/0300060519890200 ◽

2019 ◽

Vol 48 (3) ◽

pp. 030006051989020

Author(s):

Umut Kefeli ◽

Ozgur Mehtap ◽

Ozgur Cakir ◽

Ahmet Tugrul Eruyar ◽

Serkan İsgoren ◽

...

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Follicular Lymphoma ◽

Male Patient ◽

Explorative Laparotomy ◽

First Case ◽

Mild Abdominal Pain ◽

Splenic Cells ◽

History Of ◽

Unusual Symptoms

Splenosis refers to the seeding of splenic cells associated with surgery or trauma. Splenosis mimicking other diseases has been reported in the literature. To the best of our knowledge, this is the first case of follicular lymphoma in a patient with splenosis whose diagnosis of lymphoma was delayed because of a known history of splenosis. We report a 48-year-old male patient who underwent splenectomy because of injury from a high fall 20 years previously. He had no symptoms other than mild abdominal pain until 2 years previously, which was thought to be associated with splenosis. When his symptoms began to increase, he had explorative laparotomy for diagnosis, which was later confirmed as follicular lymphoma. Splenosis may delay the diagnosis of other conditions that can be underestimated. Clinicians should be aware of unusual symptoms in patients with splenosis.

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Thyroid Eye Disease

Neuro-Ophthalmology ◽

10.1093/med/9780190603953.003.0037 ◽

2019 ◽

pp. 207-212

Author(s):

Matthew J. Thurtell ◽

Robert L. Tomsak

Keyword(s):

Thyroid Dysfunction ◽

Field Testing ◽

Thyroid Eye Disease ◽

Eye Disease ◽

Management Approach ◽

Decompression Surgery ◽

Mild Disease ◽

Idiopathic Orbital Inflammation ◽

Systemic Corticosteroids ◽

History Of

Thyroid eye disease is the most common cause of orbital disease encountered in clinical practice. It most often occurs in patients with Graves disease, but can also occur in the absence of thyroid dysfunction. In this chapter, we begin by reviewing the clinical features and natural history of thyroid eye disease. We next discuss the diagnostic evaluation of thyroid eye disease, including the roles of imaging and visual field testing. We then briefly review the differential diagnosis, which includes idiopathic orbital inflammation, orbital cellulitis, and carotid-cavernous fistula. Lastly, we discuss the management approach for thyroid eye disease. Many patients have only mild disease and can be managed with supportive treatments, such as artificial tears, prisms, and selenium supplementation. However, patients with moderate to severe thyroid eye disease often require more aggressive treatments, such as immunosuppression with systemic corticosteroids, orbital irradiation, and orbital decompression surgery.

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SAT-513 Thyroid Disease And Infrared Imaging Of Eyelids

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.150 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Shannon Luu ◽

Gloria Wu ◽

Brian Leung ◽

Donia Momen ◽

Chap-Kay K Lau

Keyword(s):

Dry Eye ◽

Thyroid Disease ◽

Infrared Imaging ◽

Tear Film ◽

Thyroid Eye Disease ◽

Eye Disease ◽

Infrared Photography ◽

History Of ◽

Eye Symptoms ◽

Meibomian Glands

Abstract Background: Thyroid eye disease is thought to present as proptosis and/or severe conjunctival chemosis. Severe dry eye disease and its symptoms of non-specific eye pain and foreign body sensation in the eye can be overlooked as an early biomarker of thyroid disease. New infrared imaging can be used to evaluate dry eye and eyelid gland anatomy. Infrared imaging and detailed history of thyroid eye symptoms may lead to subsequent testing of thyroid function and more referrals to thyroid specialists. Purpose: Using infrared photography to evaluate dry eye complaints in patients: do they have thyroid disease? Methods: A retrospective chart review (2017–2019) of patients with dry eyes, eyelid imaging with infrared photography and thyroid lab testing was performed. Infrared photography with 820 nm wavelength (Heidelberg Spectralis, Heidelberg, Germany). Percentage loss of Meibomian glands was identified for each eye, then analyzed, per patient. The control population consisted of patients with no dry eye complaints, no thyroid testing or thyroid history. Exclusion criteria: patients over the age of 90 years and patients with a history of glaucoma, diabetes, cataract surgery, and eyelid surgery. Age matching was done (±5 years). Results: n=48 patients, avg age=57.73 years (sd=16.81, range 21–85 years). Thyroid patients: n=24 patients, male=10, female=14, avg age= 57.12 years (sd=16.65, med=55.5, range 23–83 years). Controls: n=24 patients, male=9, female=15, avg age=58.33 years (sd=17.30, med=58, range 21–85 years). Loss of Meibomian glands: thyroid=40.94%, control=5.10% (p<0.0001, t-test). Dry eye complaints: thyroid = 16/24, control = 0/24 (p<0.0001, x2). Discussion: Meibomian glands are glands in the upper and lower eyelids. These glands provide the lipid component of the tear film, thus slowing the evaporation of the tears and stabilizing the tear film with each blink. Meibomian gland loss would explain the dry eye symptoms in an abnormal thyroid patient population. Infrared photography can be performed with a #87 camera lens filter (cost = $65). The loss of Meibomian glands may be an early sign for thyroid disease. Conclusion: Infrared photography may be helpful in identifying severe dry eye, thus leading to increased awareness of thyroid eye disease symptoms in our patients in ophthalmology, endocrinology, and primary care.

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