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Thiazolidinedione induced thyroid associated orbitopathy

DOI: 10.1186/1471-2415-7-8

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Abstract:

We report a female patient with a history of Graves' disease and stabilised thyroid associated orbitopathy for 2.5 years, who experienced rapid progression of TAO after the initiation of thiazolidinedione for glycemic control. Following the discontinuation of TZD, the patient experienced subsequent stabilisation of disease and normalization of vision. The medical history, ophthalmic findings, and clinical course are discussed.Thiazolidinediones may exacerbate TAO, and this should be taken into consideration when selecting treatment for diabetic patients with a history of autoimmune thyroid disorders.The thiazolidinediones (TZDs) are among one of several classes of oral hypoglycemic agents commonly utilized to maintain glycemic control in patients with type 2 diabetes mellitus. While the mechanism by which TZDs increase the action of insulin is not precisely known, these agents have been shown to be potent agonists of the nuclear hormone receptor, peroxisome proliferator activated receptor-γ (PPAR-γ), which is found predominantly in adipose tissue and plays a dominant role in adipocyte differentiation [1]. A primary cause of proptosis in thyroid associated orbitopathy is the expansion of adipose tissue volume in the orbit. We report a case of a female patient with a history of Graves' disease and stabilized TAO, who experienced rapid progression of proptosis following initiation of rosiglitazone for glycemic control. This study was performed in accordance with the Declaration of Helsinski.In February 2005, a 56-year-old female smoker presented to our clinic for follow-up of her Graves' disease. Eyelid retraction was noted two years prior to presentation, but she reported no proptosis or other signs of TAO. She was diagnosed with hyperthyroidism in August 2004 and had been stabilized on propranolol and propylthiouracil. In November 2004, the patient was placed on rosiglitazone/metformin for glycemic control. Over the next several months thereafter, the patient reporte

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