Features of Visual Dysfunctions in Patients with Primary Hypothyroidism and Thyrotoxicosis

Purpose: to study the prevalence and nature of visual dysfunctions in patients with primary hypothyroidism and thyrotoxicosis.

Material and methods. The material for this study was the results of a survey of 54 patients (108 eyes) with thyroid dysfunctions: 32 people (64 eyes) with primary untreated hypothyroidism and 22 people (44 eyes) with primary untreated thyrotoxicosis. Static automated perimetry and dedicated shortwave infrared (blue-yellow) perimetry were performed. The average total value of the photosensitivity of each (n = 74) tested point of the field of view was analyzed, the topography of the location of focal defects was studied, and the severity of impairments to photosensitivity was assessed by aggregate signs.

Results. Reliably high sensitivity (92.6 %) and specificity (50.0 %) of short-wave infrared perimetry in relation to static automated perimetry were revealed. In thyroid dysfunctions, the prevalence of optic neuropathy reaches 93 % according to the data of short-wave infrared perimetry versus 7 % of static automated perimetry. It is manifested by a diffuse decrease in light sensitivity to blue stimulus with an increase in the depth of depression from the center to the periphery in both types of thyroid dysfunction. Against this background, with primary hypothyroidism, focal defects appeared in the form of first-order scotomas, and with primary thyrotoxicosis, second-order scotomas. Scotomas were located at the periphery of the central visual field, 20–30° from the fixation point. In the analyzed groups, high average group indices of the maximum corrected visual acuity were established, which allows us to speak about the safety of the photopic (cone) component of the visual analyzer.

Conclusion. The pattern of photosensitivity disorders, the topography of the location of the loci of local defects revealed by the short-wave infrared perimetry, indicate that the earliest signs of optical neuropathy are manifested at the level of photoreceptors — selectively in the S-cones. Decreased sensitivity to blue stimulus (440 nm) refers to an acquired color anomaly called tritanopia; which can be present with high visual function, is most often associated with a decrease in the number of S-cones and a deficiency of retinol (the source of cyanolab synthesis). 

1. Smith K.D., Tevaarwerk G.J, Allen L.H. An ocular dynamic study supporting the hypothesis that hypothyroidism is a treatable cause of secondary open-angle glaucoma. Can. J. Ophthalmol. 1992;27(7):341–344.

2. Wiersinga W.M., G.J. Kahaly. Graves’ Orbitopathy. Basel: Karger; 2007. 3. McKeag D. Clinical features of dysthyroid optic neuropathy: a European Group on Graves’ Orbitopathy (EUGOGO). Br. J. Ophthalmol. 2007;91:455–458. DOI: 10.1136/bjo.2006.094607

3. He J. Clinical analysis of 106 cases with elevated intraocular pressure in thyroidassociated ophthalmopathy. Yan Ke Xue Bao. 2004;20(1):10–14. DOI: 10.2147/opth.s97666

4. Brovkina A.F. Endocrine ophthalmopathy. Moscow: Geotar-Med; 2008 (In Russ.).

5. Duncan K.G. Human trabecular meshwork cells as a thyroid hormone target tissue: presence of functional thyroid hormone receptors. Graefes Arch. Clin. Exp. Ophthalmol. 1999;237(3):231–240. DOI: 10.1007/s004170050224

6. Panteleeva O.G. The modern concept of the mechanism of development of visual dysfunctions in endocrine ophthalmopathy. International Endocrinological Journal = Mezhdunarodnyj endokrinologicheskij zhurnal. 2010;27(3):14–16 (In Russ.)

7. Ohtsuka K., Nakamura Y. Open-angle glaucoma associated with Graves disease. Am J Ophthalmol. 2000;129:613–617. DOI: 10.1016/s0002-9394(99)00473-0

8. Racette L., Fischer M., Bebie H., Hollo H., Johnson C. A., Matsumoto C. Visual field digest. Review of perimetry methods on the example of Octopus perimeter. Moscow: April; 2018 (In Russ.)

9. Likhvantseva V.G., Harlap S.I., Korosteleva E.V., Solomatina M.V. Hemodynamic Disturbances in Magistral Eye Vessels and Orbit in Endocrine Ophthalmopathy as a Risk Factor in the Development of Optic Neuropathy. National Journal of Glaucoma = Natsional´nyi zhurnal glaucoma. 2014;3:14–27 (In Russ.). DOI: 10.17116/oftalma2015131432-37

10. Huna-Baron R., Glovinsky Y., Habot-Wilner Z. Comparison between Hardy-RandRittler 4th edition and Ishihara color plate tests for detection of dyschromatopsia in optic neuropathy. Graefes Arch. Clin. Exp. Ophthalmol. 2013;251:585–589. DOI: 10.1007/s00417-012-2073-x

11. Schneck M.E., Haegerstrom-Portnoy G. Color vision defect type and spatial vision in the Optic Neuritis Treatment Trial. Invest. Ophthalmol. Vis. Sc. 1997;38:2278– 2289.

12. Likhvantseva V.G., Korosteleva E.V. Ischemia of the eye on the background of primary hypothyroidism and primary thyrotoxicosis. Ophthalmology = Oftal’mologiya. 2019;3:329–335 (In Russ.). DOI: 10.18008/18165095-2019-3-329-334

13. Shchuko A.G., Pyatova Yu.S., Iureva T.N., Grishchuk A.S. Diagnostic criteria for the formation of glaucomatous optic neuropathy at the various stages of the disease. Acta Biomedica Scientifica. 2016;1(6):143–147 (In Russ.). DOI: 10.12737/23796

14. Erichev V.P., Antonov A.A. Clinical perimetry in the diagnosis and monitoring of glaucoma. Moscow: April; 2016 (In Russ.).

15. Curcio C.A., Sloan K.R. Human photoreceptor topography. The Journal of Comparative Neurology. 1990;292(4):497–523. DOI: 10.1002/cne.902920402

16. Wong K.Y., Dunn F.A., Berson D.M. Photoreceptor Adaptation in Intrinsically Photosensitive Retinal Ganglion Cells. Neuron. 2005;48(6):1001–1010 DOI: 10.1016/j.neuron.2005.11.016

17. Farhan H.Z., Joseph T.H., Stuart N.P., Katharina W., Daniel A., Joshua J.G., George C.B., Gregory-Evans K., Rizzo J.F., Charles A.C., Russell G.F., Merrick J M., Steven W.L. Short-wavelength light sensitivity of circadian, pupillary, and visual awareness in humans lacking an outer retina. Curr Biol. 2007;17(24):2122–2128. DOI: 10.1016/j.cub.2007.11.034

18. Gooley J.J, Lu J., Chou T.C., Scammell T.E., Saper C.B. Melanopsin in cells of origin of the retinohypothalamic tract. Nat. Neurosci. 2009;4(12):1165. DOI: 10.1038/nn768

19. A. Hendrickson,,D. Troilo, H. Djajadi, A. Springer. 1990; 292(4): 497—523 Expression of synaptic and phototransduction markers during photoreceptor development in the marmoset monkey Callithrix jacchus. The Journal of Comparative Neurology. 2009:512:218-231. DOI: 10.1002/cne.21893

20. Ivanovа T.V. Introduction to Applied and Computer Optics. Lecture notes. SPb: SPb GITMO (TU); 2002 (In Russ.). https://books.ifmo.ru/book/818/vvedenie_v_prikladnuyu_i_kompyuternuyu_optiku._konspekt_lekciy.htm

21. Remenko S.D. Color and vision. Chisinau: Map Moldoveneaske; 1982 (In Russ.).

22. Koshits I.N., Svetlova O.V., Egemberdiev M.B., Guseva M.G., Makarov F.N. Morphophysiological features of the structure of the macular zone of the human eye and the possible functional mechanism of focusing the eye. Russian pediatric ophthalmology = Rossiyskaya detskaya oftal’mologiya. 2019;2:112–120 (In Russ.). DOI: 10.25276/23076658-2019-2-39-51

23. Garip-Kuebler А., Halfter К., Reznicek L., Klingenstein A., Priglinger S., Hintschich C. Subclinical dysthyroid optic neuropathy: tritan deficiency as an early sign of dysthyroid optic neuropathy. Br J Ophthalmol. 2021 Jul;105(7):1019-1023. DOI: 10.1136/bjophthalmol-2020-316433

24. Kravkov S.V. The eye and its work. Moscow: USSR Academy of Sciences; 1950 (In Russ.).