ステロイドパルス治療を施行した若年者の甲状腺眼症の1例

A juvenile case of thyroid associated ophthalmopathy treated by steroid pulse therapy

要約　背景：若年者での甲状腺眼症は，軽症であることが多い。目的：外眼筋肥大がある若年者の甲状腺眼症に対し，ステロイドパルス療法が奏効した1例の報告。症例：15歳女性。易疲労感と眼球突出でバセドウ病と診断され，紹介受診した。所見と経過：視力は良好で，眼球突出は右23mm，左24mmであった。両眼瞼が腫脹し，Graefe徴候が陽性で，下方視で複視を認めた。MRIで両眼の上眼瞼挙筋の肥大があった。1年後に眼球突出と複視が増悪し，MRIで外眼筋の肥大と炎症所見がみられた。ステロイドパルス療法を3クール行い，外眼筋肥大は改善し，複視は軽減した。結論：活動性が高い甲状腺眼症に対しては，若年者であってもステロイドパルス療法が必要であり，有効である。

Abstract.　Background：Thyroid associated ophthalmopathy in young persons tends to show mild clinical manifestations. Purpose：To report thyroid associated ophthalmopathy in a young person who showed enlargement of extraocular muscles that responded to steroid pulse therapy. Case：A 15-year-old female was referred to us for generalized fatigue and proptosis since 3 months before. Findings and Clinical Course：Both eyes had full visual acuity. Proptosis was 23 mm in the right eye and 24 mm in the left. Both eyelids were swollen. Graefe sign was positive. Diplopia occurred during gazing down. Magnetic resonance imaging（MRI）showed both levator muscles to be enlarged. Proptosis progressed and diplopia became worse one year later. MRI showed enlargement and inflammation in the extraocular muscles. The patient received 3 courses of steroid pulse therapy. After steroid pulse therapy, the enlargement of extraocular muscles improved and diplopia also decreased. Conclusion：Even for young patient, steroid pulse therapy is necessary and effective for the active phase of thyroid associated ophthalmopathy.