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Acquired Strabismus and Diplopia as Initial Presentation Signs of Hyperthyroidism and Thyroid Eye Disease
갑상선기능항진과 갑상선눈병증의 첫 증상으로서 후천사시와 복시
JKOS 2020 Mar;61(3):288-93
Published online March 15, 2020;
Copyright © 2020 The Korean Ophthalmological Society.
PDF Download Count: 51 / View Count: 42

Seung Min Chung, MD1, Won Jae Kim, MD2

Department of Internal Medicine, Yeungnam University College of Medicine1, Daegu, Korea
Department of Ophthalmology, Yeungnam University College of Medicine2, Daegu, Korea
영남대학교 의과대학 내과학교실1, 영남대학교 의과대학 안과학교실2
Received June 20, 2019; Revised September 10, 2019; Accepted February 21, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: We evaluated the clinical characteristics of patients who recently acquired strabismus and diplopia as the initial presentations of hyperthyroidism and thyroid eye disease (TED).
Methods: The medical records of patients with acquired strabismus and diplopia who visited our clinic for evaluation between January 2017 and December 2018 were retrospectively reviewed; patients diagnosed initially with hyperthyroidism and TED were included in this study.
Results: A total of 410 patients were referred to our clinic for the evaluation and treatment of diplopia. Among these patients, 12 (2.9%, 12/410) showed acquired strabismus and diplopia as the initial presentation signs of hyperthyroidism and TED. The mean age of onset of diplopia was 54.7 years (range, 18-78 years). Nine patients (75%, 9/12) were male. Six male patients were active smokers at the initial presentation. Hypotropia was the most common type of strabismus (83.3%, 10/12). The mean angle of hypodeviation was 17.5 prism diopters (PD) (range, 4-40 PD). One patient showed exotropia with hypotropia and one patient showed esotropia with a bilateral up gaze limitation. Four male patients (all active smokers) underwent strabismus surgery, and one female patient underwent orbital decompression surgery.
Conclusions: The incidence of acquired strabismus and diplopia as the initial presentation sign of hyperthyroidism was predominant in male patients. Hypotropia was the most common type of strabismus. Male patients who smoked were more likely to show progression to a severe clinical course than female patients.
Keywords : Diplopia, Hyperthyrodism, Thyroid-associated ophthalmopathy


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