Ocular surface evaluation in pediatric Hashimoto's thyroiditis without thyroid-associated ophthalmopathy.

Murat Gunay,Handan Bardak,Elvin Yildiz,Nermin Koc,Heves Kirmizibekmez,Betul Onal Gunay,Gokhan Celik

doi:10.5935/0004-2749.20190056

Abstract

We aimed to assess ocular surface characteristics in children with Hashimoto's thyroiditis without thyroid-associated ophthalmopathy and compare the results with those of healthy children. Twenty-two children with Hashimoto's thyroiditis (Group 1) and 20 healthy children without any ocular and/or systemic disorder (Group 2) were enrolled in the study. Ocular Surface Disease Index questionnaire, tear film osmolarity measurement (TearLab Osmolarity System, San Diego, CA, USA), Schirmer and tear film breakup time tests, meibography, and conjunctival brush cytology were performed and compared the results between the groups. The study group included 19 girls and 3 boys in Group 1 and 12 girls and 8 boys in Group 2 (p=0.081). Thyroid-associated ophthalmopathy was not identified in any of the patients. Mean tear film osmolarity was 310.23 ± 11.98 mOsm/l in Group 1 and 313.60 ± 15.03 mOsm/l in Group 2 (p=0.424). Mean Schirmer test score was lower in Group 1 (14.91 ± 6.27) compared with Group 2 (23.60 ± 5.63) (p=0.001). Mean tear film breakup time was lower in Group 1 (11.78 ± 4.07) compared with Group 2 (15.1 ± 1.6) (p=0.013). Moreover, mean meibomian gland area loss was 25.01% ± 10.04% in Group 1 and 16.54% ± 6.02% in Group 2 (p=0.002). Conjunctival cytologic analysis in Group 1 revealed grade 0 changes in 6 patients (27.3%), grade 1 changes in 14 patients (63.6%), and grade 2 changes in 2 patients (9.1%), whereas 18 patients (90%) had grade 0 changes and 2 patients (10%) had grade 1 changes (p=0.001) in Group 2. The study demonstrates several ocular surface changes in children with Hashimoto's thyroiditis. These findings may indicate a tendency for dry eye in pediatric Hashimoto's thyroiditis patients without clinical evidence of thyroid-associated ophthalmopathy.

Highlights

Hashimoto’s thyroiditis (HT) is a chronic inflamma tion of the thyroid gland
Anti-TG antibodies were present in 90.9%, and anti-thyroid peroxidase (TPO) antibodies were found in 81.8%
Several studies have reported that the presence of Thyroid-associated ophthalmopathy (TAO) predisposes patients to ocular surface changes leading to dry eye . [14,15,16,17] Exophthalmos, a well-known condition in Graves’ ophthalmopathy, is an important cause of dry eye

Summary

Introduction

Hashimoto’s thyroiditis (HT) is a chronic inflamma tion of the thyroid gland. It is considered the most common autoimmune disease and the most common cause of hypothyroidism[1]. HT is an organ-specific autoimmune disorder characterized by diffuse goiter with lymphocytic infiltration[2]. Thyroid-associated ophthalmopathy (TAO) is a chronic autoimmune disorder typically associated with Graves’ disease and occasionally with HT. Ocular findings of TAO consist of exophthalmos, widening of palpebral fissure, lagophthalmos, and reduced tear production. These changes are responsible for the development of dry eye[6,7]

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