治療が奏効した重篤な甲状腺角結膜障害の1例―甲状腺刺激抗体の変化

A successfully treated case of severe dysthyroid ophthalmopathy: Changes in thyroid-stimulating antibody

　51歳男性が左角結膜障害と閉瞼不能で受診した。18年前に甲状腺機能亢進症と診断され加療中であったが，2年前に治療を中断した。10年前から眼瞼腫脹と眼球突出があり，2年前に角膜潰瘍が左眼に発症した。1か月前に左眼の角膜が穿孔した。初診時の矯正視力は，右0.6，左光覚弁であり，眼球突出度は右26mm，左37mmであった。瞼裂の上下幅は右12mm，左30mmであった。両眼に強い結膜充血と浮腫があり，左眼に角膜潰瘍があった。副腎皮質ステロイド薬の全身投与と球後注射，眼瞼縫合，眼窩減圧術などを行い，眼球突出と結膜浮腫は軽快した。甲状腺刺激抗体（thyroid-stimulating antibody：TSAb）は，初診時3,764％，治療後177％であった。甲状腺機能亢進症の加療でTSAbが大幅に改善した例である。

A 51-year-old male presented with severe exposure keratopathy and lagophthalmos in his left eye. He had been diagnosed with hyperthyroidism 18 years before. Medical treatment had been discontinued 2 years before. He had eyelid swelling and exophthalmos since 10 years before. Corneal ulcer had developed 2 years before. The left cornea perforated one month before. When seen by us,his corrected visual acuity was 0.6 right and light perception left. The eyeglobe protruded by 26mm right and 37mm left. The vertical eyelid opening was 12mm right and 30mm left. Both eyes showed severe conjunctival edema and hyperemia. The left eye showed corneal ulcer. We treated him with systemic and retrobulbar corticosteroid,tarsorrhaphy,orbitotomy and others. Exophthalmos and chemosis resolved. The thyroid-stimulating antibody（TSAb）was 3,764％before start of treatment and 177％after treatment. This case illustrates that improvement of dysthyroid ophthalmopathy may be associated with improved TSAb.