Ophthalmic manifestations of thyroid disease and the association of serum levels of T3, T4 and TSH with thyroid eye disease

  • Dr. Priyanka Chandrakant Choudhari Third year junior resident at department of ophthalmology, GMC, Bambolim, Goa, India
  • Dr. Ugam Usgaonkar Professor and Head, Department of Ophthalmology, GMC, Bambolim, Goa, India
  • Dr. Dipti Shrivastav Assistant lecturer, Department of Ophthalmology, GMC, Bambolim, Goa, India
Keywords: Thyroid disease, Ophthalmic manifestations, Graves’ disease


Aim: To study the ophthalmic manifestations in thyroid disease and the association of serum levels of T3, T4 and TSH with thyroid eye disease.

Material and methods: The present study was a prospective case series study. It included 72 patients with thyroid disease with either hypo, hyper or euthyroid status visiting ophthalmology department from March to October 2019, at GMC, Bambolim, Goa. Data was entered on SPSS software and analysed by using one-way ANOVA test to study the proportions of thyroid eye disease signs in various thyroid disease types and to establish their relationship with serum levels of T3, T4 and TSH and the duration of thyroid disease.

Result: The most common thyroid eye disease was found to be dry eye (41 patients) followed by upper lid retraction (19 patients) and proptosis (14 patients). Serum level of T3 at the time of study was found to be significantly correlated with the severity and the frequency of upper lid retraction. Serum levels of T4 at the time of diagnosis of hyperthyroid was found to be significantly related with the severity and the frequency of the proptosis. Rest all signs of thyroid eye disease (Chemosis, congestion, dry eye) and intraocular pressure were found to be not associated or related with serum levels of T3, T4 and TSH at the time of examination or at the time of diagnosis.

Conclusion: Duration of thyroid disease was not found to be significantly related with the frequency and severity of any of the thyroid eye disease signs which were studied with the p value being more than 0.05 in each subgroup.


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Colm McAlinden. An overview of thyroid eye disease. Eye Vis (Lond). 2014; 1: 9. doi: 10.1186/s40662-014-0009-8.

Lazarus JH. Epidemiology of Graves orbitopathy and relationship with thyroid disease. Best Pract Res Clin Endocrinol Metab. 2012; 26(3):273-279. doi: 10.1016/j.beem.2011.10.005.

Perros P, Crombie AL, Matthews JN, Kendall‐Taylor P. Age and gender influence the severity of thyroid‐associated ophthalmopathy: a study of 101 patients attending a combined thyroid‐eye clinic. Clinic Endocrinol. 1993;38(4):367-372. doi: https://doi.org/10.1111/j.1365-2265.1993.tb00516.x.

Kanskis clinical ophthalmology, A systematic approach, 8th edition 2016.

Albert Jacobiecs. Volume 3. 3rd Edition 2008. Chapter 229, Pathophysiology of Graves Orbitopathy, 2913-2926.

Perros P, Dickinson AJ, Kendall-Taylor P. Clinical presentation and natural history of Graves’ ophthalmopathy. InThyroid Eye Disease 2001 (pp. 119-136). Springer, Boston, MA. doi: https://doi.org/10.1007/978-1-4615-1447-3_8.

Vijayleela M, Babu B. Ophthalmic manifestations in thyroid disease. IOSR J Dent Med Sci. 2017;16(1):59-65. doi: 10.9790/0853-1601045965.

Raja Maheshwari, Ezkiel Weis. Thyroid associated orbitopathy. Indian J Ophthalmol. 2012;60(2):87-93. doi: 10.4103/0301-4738.94048.

Garrity JA, Bahn RS. Pathogenesis of Graves ophthalmolopathy: Implications for prediction, prevention and treatment. Am J Ophthalmol 2006:142(1):146-153. doi: https://doi.org/10.1016/j.ajo.2006.02.047.

Lehman GM, Garcia-Bates TM, Smith TJ, Feldon SE, Phipps RP. Regulation of lymphocyte function by PPARgamma: Relevance to thyroid eye disease-related inflammation. PPAR Res 2008; 2008:895901. doi: 10.1155/2008/895901.

Bartley GB, Fatourechi V, Kadrmas EF, Jacobsen SJ, Ilstrup DM, Garrity JA, et al. Clinical features of Graves ophthalmopathy in an incidence cohort. Am J Ophthalmol. 1996;121(3):284-290. doi: https://doi.org/10.1016/S0002-9394(14)70276-4.

Saks ND, Burnstine MA, Putterman AM. Glabellar rhytids in thyroid associated orbitopathy. Ophthal Plast Recontsr Surg. 2001;17(2):91-95.

Ackuaku Dogbe EM, Akpalu J, Abaidoo B. Epidemiology and clinical features of thyroid associated orbitopathy in ACCRA. Middle East Afr J Ophthalmol. 2017;24(4):183-189. doi: 10.4103/meajo.MEAJO_91_17.

Lavaju P, Badhu BP, Maskey R. Pattern of ocular manifestations in patients with thyroid disease presenting in Eastern Nepal. Thyroid Res Prac. 2019;16(1):20-25. doi: 10.4103/trp.trp_38_18.

Sabita P, Ajit T, Narayan SD, Kumar SA, Niranjan A. Ocular manifestations in thyroid eye disorder: a cross-sectional study from Nepal. Int J Clin Med. 2016;7(12):814-823. doi: 10.4236/ijcm.2016.712088.

DOI: 10.17511/jooo.2019.i08.04
Published: 2020-01-07
How to Cite
Dr. Priyanka Chandrakant Choudhari, Usgaonkar, U., & Shrivastav, D. (2020). Ophthalmic manifestations of thyroid disease and the association of serum levels of T3, T4 and TSH with thyroid eye disease. Tropical Journal of Ophthalmology and Otolaryngology, 4(8), 468-477. https://doi.org/10.17511/jooo.2019.i08.04
Original Article