LATE-ONSET THYROID EYE DISEASE IN A PATIENT WITH MULTIPLE COMORBIDITIES: A CASE REPORT

الملخص

Introduction: Thyroid eye disease (TED )is an auto-immune condition that affects the orbit around the eye, leading to inflammation and tissue remodeling. It is com-monly associated with Graves' disease but can also occur in other thyroid disorders. TED typically manifests within a few years of thyroid dysfunction, but late-onset cases, es-pecially decades after thyroidectomy, is rare. This case re-port highlights a unique presentation of TED 34 years post-thyroidectomy in a patient with multiple comorbid-ities, including hypertension, type 2 diabetes mellitus, is-chemic heart disease, and atrial fibrillation. Clinical Case: � A 75 years female with Hypertension, Type 2 Diabetes Mellitus, Ischemic Heart Disease & Atrial Fibrillation Total Thyroidectomy: Performed in 1989 due to hyper-thyroid disease, with no history of radioactive iodine abla-tion. Presenting Symptoms:Red and gritty eyes, first pre-sented in June 2023. Clinical Findings: � Orbital Examination: the patient was diagnosed with mild active thyroid eye disease. � Neck Ultrasound: Showed very small residual thyroid tissue. � TSH Receptor Antibody Test: Modestly elevated levels. � Ophthalmologist consultation: prove the diagnosis of TED. Laboratory Investigations: � HbA1c: 9.1% � Random Blood Glucose: 243 mg/dL � TSH: 26 mIU/L Medications: � Thyroxine: 100 micrograms per day � Sitagliptin/metformin: 50/1000 mg twice daily � Digoxin: 0.25 mg daily � Warfarin: 3 mg daily � Valsartan/HCT: 160/12.5 mg Initial Management: 1. Advised strict compliance with thyroxine therapy to normalize TSH levels. 2. Added basal insulin and adjusted oral anti-diabetic therapy for tighter diabetes control. 3. Recommended the use of artificial tears to keep eyes well-lubricated. 4. Prescribed selenium supplementation. 5. Referred to ophthalmologist for further evaluation. Follow-Up: � 2 Months: HbA1c improved to 8.1%, TSH decreased to 8 mIU/L, and blood pressure and cardiac arrhythmia were well controlled. Bilateral orbital examination showed sig-nificant improvement. � 6 Months: The condition progressed to mild inactive thyroid-associated eye disease. TSH receptor antibodies were just above normal, and TSH normalized to 2.1 mIU/L. Conclusion: This case illustrates the potential for TED to manifest many years after thyroidectomy, particularly in the presence of comorbid conditions This case underscores the importance of long-term mon-itoring and comprehensive management of thyroid and as-sociated conditions. While maintaining a euthyroid state is crucial for control-ling thyroid eye disease, the impact of managing other co-morbidities on TED control remains an area for further research.