Ocular features of hypothyroidism.

Abstract

Hypothyroidism is due to deficient thyroid function; myxoedema is due to diminished thyroid function associated with solid oedema. Since hypothyroidism develops very gradually and not all cases exhibit solid oedema, diagnosis is very often missed. As the incidence of this condition is more common in females than males and the age at onset corresponds to that of the menopause, diagnosis is very often confused with the menopausal syndrome or symptoms attributable to old age. Hypothyroidism may occur spontaneously in middle age or be associated with goitre, thyroidectomy, or radioactive iodine treatment. Clinically, the ocular complications of hypothyroidism are loss of eyelashes and eye brows, especially on the temporal side, puffiness of eyelids (Gull, I874), ocular irritation, corneal changes (Treacher Collins, I907), and cataract (Goulden, I928). In the past 2 years, six patients with previously undiagnosed hypothyroidism presented at the Bath Eye Infirmary with various ocular complaints. Although on questioning they had other symptoms, such as sensitivity to cold, weakness, tiredness, muscular pain, loss of scalp hair, and dry skin, the patients had not sought advice about them but had accepted these symptoms as part of the change of life associated with the menopause or had regarded them as due to old age. It was only when ocular symptoms appeared that they sought medical advice. Hypothyroidism was suspected from answers to further questions, ocular complications, facial features, slow pulse, and relatively low blood pressure. Clinical diagnosis was confirmed by serum thyroxine iodine, free thyroxine index, cholesterol, and electrocardiogram. The ocular findings and results of laboratory investigations in these six patients are set out in the Table.