Progressive Ophtahalmopathy in an Elderly Man

Question

I hope you will be able to provide information or direct me to literature on the following....my 82 year old father was diagnosed with Hashimoto Hypothyroidism 2 years ago. One year later, he developed significant thyroid associated ophthalmopathy including diplopia and proptosis (one eye worse then the other). After 4 months of worsening symptoms, orbital X-ray was performed. Initially, follow-up exams indicated improvement. Now, 2 years after the initial diagnosis of Hashimoto Hypothyroidism, he has Graves Disease, and the eye that initially had minimal involvement now has significantly proptosis.

My dad is being seen at Columbia Presbyterian for the Thyroid Associated Opthalmopathy, and his endocrinologist recently stopped the thyroid supplement as he has now gone from hypo to hyperthyroidism. One other worthy note - Myesthneia Gravis was ruled out

The outstanding question I have is - how long does Thyroid Associated Opthalmopathy tend to last in seniors, and is thyroid related medical treatment different for someone in his age group? Any information, or reference to literature on TAO in seniors would be greatly appreciated.

Thank You,Birdie D'Andrea,RN

Response

Dear Ms. D'Andrea, Thyroid-associated ophthalmopathy is most common in women in their 40s and 50s, and is fairly uncommon in elderly men. I know of no study concerning differences in the eye problems or responses to treatment in the elderly. However, in my experience and in that of others, there does seem to be more involvement of the eye muscles with diplopia in the elderly, while younger patients tend to have more enlargement of the fat tissues behind the eyes with proptosis and extensive inflammation. That said, clearly your father has a combination of both. I would recommend the same eye treatment for him as I would for a younger person. As the specifics would depend on the details of his eye exam and discussions with him, I can not tell you exactly what (if any) eye treatment I would recommend for him at present.The duration of eye problems varies considerably from patient to patient, ranges from about 6 months to several years' time, and does not seem to be related to the age of the patient. The type of treatment needed for his hyperthyroidism is also not directly age-dependant, but would depend on his general health status. It is particularly important in the elderly to maintain normal thyroid hormone levels as older individuals are especially prone to heart problems when hyperthyroid. Rebecca Bahn, MD