MALIGNANT EXOPHTHALMOS OR EXOPHTHALMIC OPHTHALMOPLEGIA

Abstract

Summary of Case Histories Here follows a summary of the last five cases; no surgical measures were adopted; the treatment consisted in raising the basal metabolic rate so as to increase water excretion. In all of them the disease has been controlled. K., aged thirty-six years, a gardener, had a traumatic blind left eye for twenty years. He had severe thyreotoxicosis. His basal metabolic rate was + 49%. Exophthalmos was marked in both eyes. Small corneal ulcer of his good eye was present and healed before operation. In consultation with Dr. Cronin and Dr. Pairclough, it was decided to perform thyreoidectomy as the toxic symptoms were so severe. After operation the basal metabolic rate became normal, but the eyes became worse with definite ophthalmoplegia. For twelve months two grains of thyreoid extract were given three times a day; this kept the basal metabolic rate up to + 25% or thereabouts. During this time the patient went back to his work as a gardener, wearing dark glasses. For this last six months he has taken no thyreoid extract and has no trouble with his good eye, though it is still somewhat prominent. McD., aged thirty years, a labourer, suffered from thyreotoxicosis, but had no exophthalmos. Exophthalmos was developing slowly after operation six months previously. One grain of thyreoid extract was given twice a day. As the pulse rate was 100, the dose of thyreoid extract was kept small. The basal metabolic rate was now + 3–9%, and the pulse rate 120. The exophthalmos is becoming less, but slight papilledema is present. The patient's condition is definitely improving. E., aged forty-six years, a soldier, had an operation for thyreotoxicosis eighteen months ago. The basal metabolic rate before operation was over + 30%. Fifteen months after the operation he reported again, saying that for three months his symptoms of thyreotoxicosis were gradually recurring; but this time exophthalmos was present with oedema of the lids. The basal metabolic rate was +46%. The remnants of gland tissue left at the operation had increased in size so much that each side of the patient's neck was bigger than before the previous operation. Owing to the oedema of the lids, only the right recurrence was removed. After this operation the patient developed tetany, which was kept under control with calcium and “AT10”. The right fundus showed mild papillcedema. The patient is being treated with two grains of thyreoid extract three times a day, and is improving so much that he is returning to work. Mrs. W., aged forty-four years, suffered from thyreotoxicosis, but had no exophthalmos. In February, 1943, she was subjected to thyreoidectomy. She was seen again in February, 1944. Her eyelids were oedematous and her eyes prominent and painful. She was given two grains of thyreoid extract three times a day and her basal metabolic rate was raised to + 36%. Two months later her eyes were much better. G., aged forty-seven years, was a bank clerk. In December, 1943, he was thought possibly to be suffering from malignant exophthalmos with thyreotoxicosis. His basal metabolic rate was + 53%. Operation was performed in December, 1943. In March, 1944, the basal metabolic rate was +7%. The eyes were more prominent and reddened, and oedema of the lids and pain were present. Treatment consisted in the administration of one grain of thyreoid extract twice a day. In August, 1944, the patient's condition was much improved.