갑상샘눈병증에 동반된 눈중증근무력증 1예
Ocular Myasthenia Gravis in Conjunction with Thyroid-Associated Ophthalmopathy: A Case Report
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목적: 비일치 사시와 안검하수를 보이는 환자에서 갑상샘눈병증과 눈중증근무력증을 동시에 진단하고 치료한 경험 1예를 보고하고자한다. 증례요약: 과거력이 없는 46세 남자 환자가 내원 1달 전부터 발생한 양안 복시로 내원하였다. 1달간 7 kg의 체중 감소가 있었고 안과검사에서 좌안 상사시와 외사시, 그리고 우안 눈꺼풀 부종과 눈꺼풀처짐, 안구돌출이 있었다. 원인 감별을 위해 시행한 전신 검사에서그레이브스병으로 진단되었고 고용량 부신피질호르몬 주사요법을 시행하여 복시와 눈꺼풀부종은 회복되는 양상을 보였다. 그러나 눈꺼풀처짐은 호전되지 않아 눈중증근무력증 의증하에 추가로 시행한 검사에서 항아세틸콜린 수용체 항체(Anti-acetylcholine receptor antibody) 양성을 보이고, 항콜린에스터레이스 복용 후 눈꺼풀처짐 증상이 극적으로 호전되어 본 환자는 갑상샘눈병증과 눈중증근무력증이 동반되어 있는 것으로 진단하였다. 결론: 갑상샘눈병증 환자에서 눈꺼풀처짐이 있을 때는 눈중증근무력증의 동반 가능성을 고려하여야 한다.
Abstract
Purpose: To report a case of ocular myasthenia gravis in conjunction with thyroid-associated ophthalmopathy in a patient who showed incomitant strabismus and blepharoptosis as well as to discuss the clinical features and tests that may help distinguish these 2 diseases. Case summary: A 46-year-old man without any previous history of systemic and ophthalmic disease presented with binocular diplopia that occured a month earlier. The patient had no other systemic symptoms except a 7 kg weight loss within the last month. The patient was referred to the department of internal medicine and brain magnetic resonance imaging was performed to ascertain the cause of suspected left superior oblique muscle palsy. The patient was diagnosed with Graves’disease and underwent medical treatment. One month later, the patient presented with consistent diplopia and exophthalmos and showed a swelling of eyelid and ptosis in the right eye. Intravenous high-dose steroid therapy was administered to the patient. After the treatment, symptoms of diplopia and lid swelling were improved, however ptosis persisted. Ocular myasthenia gravis was suspected and various tests were conducted. Anti-acetylcholine receptor antibodies were detected in large amounts and ptosis was improved dramatically by an administration of an anticholinesterase agent. The patient was diagnosed with ocular myasthenia gravis in conjunction with thyroid-associated ophthalmopathy. Conclusions: Ocular myasthenia gravis should be suspected in patients with thyroid-associated ophthalmopathy who have signs or symptoms of ptosis.
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