A Case Report on Severe Hypothyroidism Associated With Complete Bilateral Ptosis: A Rare Presentation

Abstract

Thyroid hormones exert a major control over many vital functions of the human body and thus have an important role in maintaining homeostasis. Therefore, the hypothyroid state is associated with a wide spectrum of symptoms affecting almost all bodily functions. Among the major organs affected, nervous system and body metabolism are severely affected. Facial appearance, including ocular changes, is a characteristic of the hypothyroid state. The most prominent ocular features of hypothyroidism include loss of eyelashes and eyebrows, especially on the temporal side, puffiness of the eyelids, ocular irritation and ocular protrusion. Mild drooping of the eyelids is also seen in some patients due to loss of sympathetic tone; however the occurrence of complete bilateral ptosis is rare in the setting of hypothyroidism. Our patient, who presented with sudden onset bilateral ptosis, had no manifestations of diseases involving the ocular structure, cranial nerves or central nervous system primarily; the cause may be attributed to severe hypothyroidism considering the dramatic response to thyroxine replacement therapy.