Abstract
BackgroundTo describe an episode of thyroid associated orbitopathy (TAO) following the initiation of thiazolidinedione (TZD).Case presentationWe report a female patient with a history of Graves' disease and stabilised thyroid associated orbitopathy for 2.5 years, who experienced rapid progression of TAO after the initiation of thiazolidinedione for glycemic control. Following the discontinuation of TZD, the patient experienced subsequent stabilisation of disease and normalization of vision. The medical history, ophthalmic findings, and clinical course are discussed.ConclusionThiazolidinediones may exacerbate TAO, and this should be taken into consideration when selecting treatment for diabetic patients with a history of autoimmune thyroid disorders.
Highlights
To describe an episode of thyroid associated orbitopathy (TAO) following the initiation of thiazolidinedione (TZD).Case presentation: We report a female patient with a history of Graves' disease and stabilised thyroid associated orbitopathy for 2.5 years, who experienced rapid progression of TAO after the initiation of thiazolidinedione for glycemic control
Thiazolidinediones may exacerbate TAO, and this should be taken into consideration when selecting treatment for diabetic patients with a history of autoimmune thyroid disorders
While the mechanism by which TZDs increase the action of insulin is not precisely known, these agents have been shown to be potent agonists of the nuclear hormone receptor, peroxisome proliferator activated receptor-Îł (PPAR-Îł), which is found predominantly in adipose tissue and plays a dominant role in adipocyte differentiation [1]
Summary
The thiazolidinediones (TZDs) are among one of several classes of oral hypoglycemic agents commonly utilized to maintain glycemic control in patients with type 2 diabetes mellitus. We report a case of a female patient with a history of Graves' disease and stabilized TAO, who experienced rapid progression of proptosis following initiation of rosiglitazone for glycemic control. The patient was found to have a right thyroid nodule, which, on cytological examination of samples obtained by fine-needle aspiration, revealed atypical cells. She proceeded to have a right hemithyroidectomy for further management. Early synthroid replacement was initiated to prevent hypothyroidism and possible deterioration of her TAO Based on her MRI findings and profound proptosis on the left side, the decision was made to proceed with orbital decompression surgery prior to further treatment of the papillary cancer with I131 ablation. Physical examination findings were unchanged, with Hertel measurements 25 mm on the right and 29 mm on the left (Figure 1D)
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