Method - A 60 year old male presented to eye OPD for Right hypotropia with vertical diplopia since 6 months. Detailed clinical history revealed a diagnosed case of thyroid since 2006, and he discontinued the thyroid medications after 2014 as his thyroid markers normalized. At the time of presentation, proper ocular examination was conducted including Best Corrected Visual Acuity (BCVA), Extra Ocular Movement (EOM), differential Intra Ocular Pressure (IOP), Prism Bar Cover Test (PBCT), Worth Four Dot Test (W4DT), Force Duction Test (FDT) and Magnetic Resonance Imaging (MRI).
Result - At the time of presentation, BCVA of right eye was 6/6P and 6/9P in left eye. On Hirschberg’s Test right hypertropia noted. PBCT revealed 90 prism Dioptre with diplopia on W4DT on depression. EOM was restricted in dextro-depression. IOP of right eye was 27.7mmHg with rise in downgaze. MRI was suggestive of thyroid ophthalmopathy/orbitopathy with bilateral involvement of muscle bellies (medial rectus + inferior rectus) and sparing of tendinous 5insertion with bilateral increase in retro-orbital fat.
Conclusion – A recent case with natural progression of Thyroid Eye Disease in the backdrop of normal thyroid markers without medications is a learning experience. Resuming anti-thyroid was not suggested by the Endocrinologist in view of normal thyroid profile and the role of steroids in such a case was not definite. A surgical procedure for inferior rectus recession holds benefit but extent to which favourable surgical outcomes withstand a natural progression cannot be commented upon by just one case alone.
Keywords: Thyroid, Orbitopathy, Hypertropia, Diplopia