Optic Neuropathy Following Acute Decompensated Hypothyroidism (Myxedema Crisis)

Abstract

Myxedema crisis (MC) refers to an unusual state of regulatory dysfunction precipitated by uncontrolled hypothyroidism. The pathogenic consequences of MC are broad and may contribute to significant bodily decompensation across multiple organ systems. However, shock-induced ischemic optic neuropathy (SION) in this setting has not been reported previously. Here, we present the case of a 76-year-old female with presumed bilateral optic neuropathy following abdominal surgery. The patient experienced a prolonged and complicated postoperative course in which she remained off supplemental levothyroxine. Subsequently, her clinical status deteriorated until she met diagnostic criteria for acute decompensated hypothyroidism (MC). Upon awakening from a comatose state, she reported significant vision loss. A neuro-ophthalmologic evaluation later confirmed significant constriction of her visual fields, optic disc pallor, and global retinal nerve fiber layer loss consistent with nonarteritic ischemic optic neuropathy.

Keywords: anemia; hypotension; myxedema crisis; nonarteritic ischemic optic neuropathy; shock-induced ischemic optic neuropathy.

Figure 1. Automated perimetry (Humphrey visual field), performed three months after vision loss, demonstrates superior and inferior arcuate defects bilaterally

OS: oculus sinister; OD: oculus dextrus

Figure 2. Fundus examination performed three months after vision loss with optic disc pallor bilaterally