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Reversible increase of intraocular pressure in subclinical hypothyroid patients

Objective: The aim of the study was to analyse the relationship between the ocular parameters, namely intraocular pressure (IOP), and the early forms of subclinical hypothyroidism.

Design: Fifty-three subjects (9 male and 44 female) aged from 18 to 45 years (mean 32±7 years) were selected for this study. Twenty-nine met the criteria of subclinical hypothyroidism and 24 euthyroid subjects, age- and sex-matched, were used as controls.

Methods: All individuals underwent a complete ocular examination, including visual field examination and serial measurement of IOP by means of a Goldmann tonometer. A tonographic examination was also performed.

Results: The hypothyroid patients showed a substantially higher pressure in both eyes compared with control subjects (right eye=17·52±4·74 vs 13·42±1·95 mmHg, p<0.0001; left eye=17·55±3·99 vs 13·71±1·55 mmHg, p<0.0001). Indeed, the tonometric pressure exceeded 18 mmHg in 11 out of the 29 (38%) patients in the right eye and in 8 out of 29 (27%) patients in the left eye. The outflow index was normal in all subjects except in two hypothyroid patients. After two months of L-thyroxine (L-T₄) replacement therapy, only one patient continued to show tonometric values above 18 mmHg and the hypothyroid patients showed a significant reduction in mean IOP in both eyes compared with pretreatment values (right eye=14·96± 1·32 mmHg. p<0.0097; left eye=15·03± 1·38 mmHg, p<0.0018). Treatment did not lead to any change in the outflow indices; however, the C value (outflow coefficient at the sclerocorneal corner) returned to normal in the two patients with increased pre-treatment tonographic values.

Conclusions: These findings indicate that the intraocular pressure is increased even in subclinical hypothyroid patients and that, at this early stage, the impairment is fully reversible with L-T₄ therapy.

European Journal of Endocrinology 136 595–598