Autoimmune thyroid gland disease predisposes to orbital lymphoma

Abstract

6641 Of 369 consecutive, biopsy proven, orbital lymphoma patients presenting to Moorfield’s/Barts (1979–1999), 20 (5%) had a history of thyroid gland disease and adequate notes were available for scrutiny in ten. All ten patients had laboratory evidence of autoimmune thyroid disease at 11–27 (median 17.5) years prior to the diagnosis of orbital lymphoma and 6/10 had overt ophthalmopathy - none having received orbital radiotherapy. Using a calculated estimate of 0.4% prevalence of thyroid ophthalmopathy in UK (being 30% of 1.4% UK prevalence of autoimmune thyroid disease:Thyroid 1998;8:427–8; Brit Med J 2004; 329: 385–90), the probability of this occurring by chance is low (p=0.007) and our result is probably an underestimate. All lymphomas were solely orbital (unilateral IE) at presentation, being marginal zone in 9/10 and diffuse large B-cell lymphoma in the other. The tumour affected mainly conjunctiva (5/10), lacrimal gland (2/10) and retrobulbar tissues (1/10) - the anterior location cases being of interest in that thyroid ophthalmopathy mainly affects the retrobulbar tissues but MALT (and from our data most sporadic orbital lymphomas: Brit J Ophthalmol 2000; 84: 907–13; Eye 2003; 17: 809–820) occur anteriorly in the orbit. Conclusions: Autoimmune thyroid gland disease predisposes to orbital lymphoma. No significant financial relationships to disclose.