Non Atrial Fibrillation related Central Retinal Artery Occlusion (CRAO) in Hyperthyroidism: A Case Report
Keywords:
Atrial fibrillation (AF), Central Retinal Artery Occlusion (CRAO), Hyperthyroidism
Abstract
We report a case of non AF related Central retinal artery occlusion (CRAO) (Stroke) in untreated & uncontrolled hyperthyroidism. CRAO can be considered as an ocular analogue of stroke or an ocular equivalent of acute myocardial infarction. Generally hyperthyroidism is associated with Stroke (CRAO) because of atrial fibrillation. However, we report a case of uncontrolled hyperthyroidism with CRAO in the absence of atrial fibrillation. It is with an intent to highlight the fact that a hyperthyroid state is not only complicated by AF, but even hyperthyroidism in itself is a potential risk factor in the causation of stroke.We came across only one case report of ischaemic stroke in a hyperthyroid patient without AF. We could not find any case report of hyperthyroidism with AF related CRAO in literature. Hence we report first case of non AF related CRAO in hyperthyroidism & perhaps second case report of non AF related stroke in hyperthyroidism in literature so far. An uncontrolled hyperthyroid state is tantamount to a sustained inflammatory state that results in endothelial dysfunction by causing hypercoagulable state culminating in a small caliber vessel blockage.
Downloads
Download data is not yet available.
References
1. Onwelekwe I, Eze C, Ekenzze O. Ischaemic Stroke in hyperthyroidism without cardiac arrhythmia : A Case report from South east Nigeria. Niger J Med 2012;21(4):458-61. [PubMed]
2. Kunimoto.Vascular diseases of the retina, AT Still University SOMA, 2012.http://en.wikipedia.org/wiki/Central_retinal_artery_occlusion. 21-12-2014.
3. Central and branch retinal artery occlusion. Update.com. Mar 14,2012. [PubMed]
4. Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002 Feb;87(2):489-99.
5. Flynn RWV, MacDonald TM, Morris AD, Jung RT, Leese GP. The thyroid epidemiology, audit, and research study: thyroid dysfunction in the general population. J Clin Endocrino Metab. 2004;89:3879 –3884. [PubMed]
6. Retianal artery occlusion: Medline Plus Medical Encyclopedia. http://www.nIm.nih.gov/medlineplus/ency/article/001028.htm
7. Kollarits CR, Lubow M, Hissong SL. Retinal Strokes: I: Incidence of carotid atheromata. JAMA 1972;222:1273-5. [PubMed]
8. Von Graefe A. Ueber Embolie der Arteria centralis retinae als Ursache plotzlicher Erblindung. Albrecht von Graefes Arch Ophthalmol 1859;5:136-57.
9. Brown GC, Magargal LE, Shields JA, Goldberg RE, Walsh PN. Retinal arterial obstruction in children and young adults.Ophthalmology 1981;88:18-25.
10. Clarke R, Daly L, Robinson K et al. Hyperhomocysteinemia: An Independent risk factor for vascular disease. N Engl J Med 1991;324:1149. [PubMed]
11. Dan L. Longo et al. Harrison's Principles of Internal Medicine, 18th Edition. New York. The McGraw Hill Companies, Inc. 2011.3274-80.
12. Rumelt S, Dorenboim Y, Rehany U. Aggressive systematic treatment for central retinal artery occlusion. Am J Ophthalmol 1999;128:733-8.
13. Greven CM, Slusher MM, Weaver RG. Retinal arterial occlusion in young adults. Am J Ophthalmol 1995;120:776-83. [PubMed]
14. Brown GC, Magargal LE. Central retinal artery occlusion and visualacuity. Ophthalmology 1982;89:14-9. [PubMed]
15. Karjalainen K. Occlusion of the central retinal artery and retinal branch arterioles: A clinical, tonographic and fluorescein angiographic study of 175 patients. Acta Ophthalmol 1971;109:1-95. [PubMed]
16. Gronemeyer A, Arsène S, Le Lez ML, Rateau J. Central retinal artery occlusion or branch retinal artery occlusion in the young associated with high lipoprotein (a) levels. J Fr Ophtalmol 2002;25:727-30. [PubMed]
17. Murata M, Saito T, Takahashi S, Ichinose A. Plasma lipoprotein(a) levels are high in patients with central retinal artery occlusion.Thromb Res 1998;91:169-75. [PubMed]
18. Suvajac G, Stojanovich L, Milenkovich S. Ocular manifestations in antiphospholipid syndrome. Autoimmun Rev 2007;6:409-14. [PubMed]
19. Au A, O’Day J. Review of severe vaso-occlusive retinopathy in systemic lupus erythematosus and the antiphospholipid syndrome: Associations, visual outcomes, complications and treatment. Clin Exp Ophthalmol 2004;32:87-100.
20. Beatty S, Au Eong KG. Local intra-arterial fibrinolysis for acute occlusion of the central retinal artery: a meta-analysis of the published data. Br J Ophthalmol. 2000;84:914–916. [PubMed]
21. Plant GT, Landau K. Thrombolysis for central retinal artery occlusion. J Neurol Neurosurg Psychiatry.2005;76:160–161. [PubMed]
22. Hayreh SS. Retinal arterial occlusion with LIF using rTPA. Ophthalmology. 1999;106:1236–1239. [PubMed]
23. Schumacher M, Schmidt D, Wakhloo AK. Intra-arterial fibrinolytic therapy in central retinal artery occlusion. Neuroradiology. 1993;35:600–605. [PubMed]
24. Rumelt S, Brown GC. Update on treatment of retinal arterial occlusions. Curr Opin Ophthalmol.2003;14:139–141. [PubMed]
25. Biousse V, Calvetti O, Bruce BB, Newman NJ. Thrombolysis for central retinal artery occlusion. J Neuroophthalmol. 2007;27:215–230. [PubMed]
26. Frost L, Vestergaard P, Mosekilde L. Hyperthyroidism and risk of atrial fibrillation or flutter: a population-based study. Arch Intern Med. 2004;164:1675–1678. [PubMed]
27. Squizzato A, Gerdes VEA, Brandjes DP, Bullar HR, Stam J. Thyroid diseases and cerebrovascular disease. Stroke. 2005;36:2302–2310. [PubMed]
28. Cacciatori V, Bellavere F, Pezzarossa A, Dellera A, Gemma ML, Thomaseth K, et al. Power spectral analysis of heart rate in hyperthyroidism. J Clin Endocrinol Metab 1996;81(8):2828–35. [PubMed]
29. Bielecka-Dabrowa A, Mikhailidis DP, Rysz J, Banach M. The mechanisms of atrial fibrillation in hyperthyroidism. Thyroid Res 2009;2(1):4. [PubMed]
30. Nadkarni PJ, Sharma M, Zinsmeister B, Wartofsky L, Burman KD. Thyrotoxicosis-induced ventricular arrhythmias. Thyroid 2008;18(10):1111–4. [PubMed]
31. Resnick LM, Laragh JH. Plasma renin activity in syndromes of thyroid hormone excess and deficiency. Life Sci 1982;30(7–8):585–6. [PubMed]
32. Polikar R, Burger AG, Scherrer U, Nicod P. The thyroid and the heart. Circulation 1993;87(5):1435–41. [PubMed]
33. Ojamaa K, Klemperer JD, Klein I. Acute effects of thyroid hormone on vascular smooth muscle. Thyroid 1996;6(5):505–12. [PubMed]
34. Franchini M, Montagnana M, Manzato F, Vescovi PP. Thyroid dysfunction and hemostasis: an issue still unresolved. Semin Thromb Hemost 2009;35(3):288–94. [PubMed]
35. Erem C, Ersoz HO, Karti SS, Ukinc K, Hacihasanoglu A, Deger O, Telatar M. Blood coagulation and fibrinolysis in patients with hyperthyroidism. J Endocrinol Invest 2002;25(4):345–50. [PubMed]
36. Petersen P, Hansen JM. Stroke in thyrotoxicosis with atrial fibrillation. Stroke 1988;19(1):15–8. [PubMed]
37. Osman F, Franklyn JA, Holder RL, Sheppard MC, Gammage MD.Cardiovascular manifestations of hyperthyroidism before and after antithyroid therapy: a matched case-control study. J Am Coll Cardiol. 2007;49:71– 81. [PubMed]
38. Inaba M, Henmi Y, Kumeda Y, Ueda M, Nagata M, Emoto M, Ishikawa T, Ishimura E, Nishizawa Y. Increased stiffness in common carotid artery in hyperthyroid Graves’ disease patients. Biomed Pharmacother. 2002;56:241–246. [PubMed]
39. Volzke H, Robinson DM, Schminke U, Ludemann J, Rettig R, Felix SB,Kessler C, John U, Meng W. Thyroid function and carotid wall thickness.J Clin Endocrinol Metab. 2004;89:2145–2149.
40. Erem C. Coagulation and fibrinolysis in thyroid dysfunction. Endocrinology.2009;36:110 –118.
41. Erem C, Ersoz HO, Karti SS, Ukinc K, Hacihasanoglu A, Deger O,Telatar M. Blood coagulation and fibrinolysis in patients with hyperthyroidism. J Endocrinol Invest. 2002;25:345–350.
42. Homoncik M, Gessl A, Ferlitsch A, Jilma B, Vierhapper H. Altered platelet plug formation in hyperthyroidism and hypothyroidism. J Clin Endocrinol Metab. 2007;92:3006 –3012. [PubMed]
43. Ostrander LD Jr, Brandt RL, Kjelsberg MO, Epstein FH. Electrocardiographic findings among the adult population of a total natural community, Tecumseh, Michigan. Circulation 1965;31:888–98.
44. Petersen P. Thromboembolic complications in atrial fibrillation. Stroke.1990;21:4 –13.
45. Heeringa J, Hoogendoorn EH, van der Deure WM, Hofman A, Peeters RP, Hop WC, et al. High-normal thyroid function and risk of atrial fibrillation: the Rotterdam study. Arch Intern Med 2008;168(20):2219–24.
46. Petersen P, Boysen G, Godtfredsen J, Andersen ED, Andersen B.Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation.The Copenhagen AFASAK Study. Lancet. 1989;1:175–179.
47. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE III. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24:35– 41.
48. Lee TH, Hsu WC, Chen CJ, Chen ST. Etiologic study of young ischemic stroke in Taiwan. Stroke. 2002;33:1950 –1955.
49. Putaala J, Metso AJ, Metso TM, Konkola N, Kraemer Y, Haapaniemi E, Kaste M, Tatlisumak T. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki Young Stroke Registry.Stroke. 2009;40:1195–1203. [PubMed]
50. Sheu JJ, Kang JH, Lin HC: Hyperthyroidism and risk of ischemic stroke in young adults: a 5-year follow-up study. Stroke 2010; 41: 961–966.Cardiology 2014;128:51-53. DOI: 10.1159/000357613. www.karger.com/crd
2. Kunimoto.Vascular diseases of the retina, AT Still University SOMA, 2012.http://en.wikipedia.org/wiki/Central_retinal_artery_occlusion. 21-12-2014.
3. Central and branch retinal artery occlusion. Update.com. Mar 14,2012. [PubMed]
4. Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002 Feb;87(2):489-99.
5. Flynn RWV, MacDonald TM, Morris AD, Jung RT, Leese GP. The thyroid epidemiology, audit, and research study: thyroid dysfunction in the general population. J Clin Endocrino Metab. 2004;89:3879 –3884. [PubMed]
6. Retianal artery occlusion: Medline Plus Medical Encyclopedia. http://www.nIm.nih.gov/medlineplus/ency/article/001028.htm
7. Kollarits CR, Lubow M, Hissong SL. Retinal Strokes: I: Incidence of carotid atheromata. JAMA 1972;222:1273-5. [PubMed]
8. Von Graefe A. Ueber Embolie der Arteria centralis retinae als Ursache plotzlicher Erblindung. Albrecht von Graefes Arch Ophthalmol 1859;5:136-57.
9. Brown GC, Magargal LE, Shields JA, Goldberg RE, Walsh PN. Retinal arterial obstruction in children and young adults.Ophthalmology 1981;88:18-25.
10. Clarke R, Daly L, Robinson K et al. Hyperhomocysteinemia: An Independent risk factor for vascular disease. N Engl J Med 1991;324:1149. [PubMed]
11. Dan L. Longo et al. Harrison's Principles of Internal Medicine, 18th Edition. New York. The McGraw Hill Companies, Inc. 2011.3274-80.
12. Rumelt S, Dorenboim Y, Rehany U. Aggressive systematic treatment for central retinal artery occlusion. Am J Ophthalmol 1999;128:733-8.
13. Greven CM, Slusher MM, Weaver RG. Retinal arterial occlusion in young adults. Am J Ophthalmol 1995;120:776-83. [PubMed]
14. Brown GC, Magargal LE. Central retinal artery occlusion and visualacuity. Ophthalmology 1982;89:14-9. [PubMed]
15. Karjalainen K. Occlusion of the central retinal artery and retinal branch arterioles: A clinical, tonographic and fluorescein angiographic study of 175 patients. Acta Ophthalmol 1971;109:1-95. [PubMed]
16. Gronemeyer A, Arsène S, Le Lez ML, Rateau J. Central retinal artery occlusion or branch retinal artery occlusion in the young associated with high lipoprotein (a) levels. J Fr Ophtalmol 2002;25:727-30. [PubMed]
17. Murata M, Saito T, Takahashi S, Ichinose A. Plasma lipoprotein(a) levels are high in patients with central retinal artery occlusion.Thromb Res 1998;91:169-75. [PubMed]
18. Suvajac G, Stojanovich L, Milenkovich S. Ocular manifestations in antiphospholipid syndrome. Autoimmun Rev 2007;6:409-14. [PubMed]
19. Au A, O’Day J. Review of severe vaso-occlusive retinopathy in systemic lupus erythematosus and the antiphospholipid syndrome: Associations, visual outcomes, complications and treatment. Clin Exp Ophthalmol 2004;32:87-100.
20. Beatty S, Au Eong KG. Local intra-arterial fibrinolysis for acute occlusion of the central retinal artery: a meta-analysis of the published data. Br J Ophthalmol. 2000;84:914–916. [PubMed]
21. Plant GT, Landau K. Thrombolysis for central retinal artery occlusion. J Neurol Neurosurg Psychiatry.2005;76:160–161. [PubMed]
22. Hayreh SS. Retinal arterial occlusion with LIF using rTPA. Ophthalmology. 1999;106:1236–1239. [PubMed]
23. Schumacher M, Schmidt D, Wakhloo AK. Intra-arterial fibrinolytic therapy in central retinal artery occlusion. Neuroradiology. 1993;35:600–605. [PubMed]
24. Rumelt S, Brown GC. Update on treatment of retinal arterial occlusions. Curr Opin Ophthalmol.2003;14:139–141. [PubMed]
25. Biousse V, Calvetti O, Bruce BB, Newman NJ. Thrombolysis for central retinal artery occlusion. J Neuroophthalmol. 2007;27:215–230. [PubMed]
26. Frost L, Vestergaard P, Mosekilde L. Hyperthyroidism and risk of atrial fibrillation or flutter: a population-based study. Arch Intern Med. 2004;164:1675–1678. [PubMed]
27. Squizzato A, Gerdes VEA, Brandjes DP, Bullar HR, Stam J. Thyroid diseases and cerebrovascular disease. Stroke. 2005;36:2302–2310. [PubMed]
28. Cacciatori V, Bellavere F, Pezzarossa A, Dellera A, Gemma ML, Thomaseth K, et al. Power spectral analysis of heart rate in hyperthyroidism. J Clin Endocrinol Metab 1996;81(8):2828–35. [PubMed]
29. Bielecka-Dabrowa A, Mikhailidis DP, Rysz J, Banach M. The mechanisms of atrial fibrillation in hyperthyroidism. Thyroid Res 2009;2(1):4. [PubMed]
30. Nadkarni PJ, Sharma M, Zinsmeister B, Wartofsky L, Burman KD. Thyrotoxicosis-induced ventricular arrhythmias. Thyroid 2008;18(10):1111–4. [PubMed]
31. Resnick LM, Laragh JH. Plasma renin activity in syndromes of thyroid hormone excess and deficiency. Life Sci 1982;30(7–8):585–6. [PubMed]
32. Polikar R, Burger AG, Scherrer U, Nicod P. The thyroid and the heart. Circulation 1993;87(5):1435–41. [PubMed]
33. Ojamaa K, Klemperer JD, Klein I. Acute effects of thyroid hormone on vascular smooth muscle. Thyroid 1996;6(5):505–12. [PubMed]
34. Franchini M, Montagnana M, Manzato F, Vescovi PP. Thyroid dysfunction and hemostasis: an issue still unresolved. Semin Thromb Hemost 2009;35(3):288–94. [PubMed]
35. Erem C, Ersoz HO, Karti SS, Ukinc K, Hacihasanoglu A, Deger O, Telatar M. Blood coagulation and fibrinolysis in patients with hyperthyroidism. J Endocrinol Invest 2002;25(4):345–50. [PubMed]
36. Petersen P, Hansen JM. Stroke in thyrotoxicosis with atrial fibrillation. Stroke 1988;19(1):15–8. [PubMed]
37. Osman F, Franklyn JA, Holder RL, Sheppard MC, Gammage MD.Cardiovascular manifestations of hyperthyroidism before and after antithyroid therapy: a matched case-control study. J Am Coll Cardiol. 2007;49:71– 81. [PubMed]
38. Inaba M, Henmi Y, Kumeda Y, Ueda M, Nagata M, Emoto M, Ishikawa T, Ishimura E, Nishizawa Y. Increased stiffness in common carotid artery in hyperthyroid Graves’ disease patients. Biomed Pharmacother. 2002;56:241–246. [PubMed]
39. Volzke H, Robinson DM, Schminke U, Ludemann J, Rettig R, Felix SB,Kessler C, John U, Meng W. Thyroid function and carotid wall thickness.J Clin Endocrinol Metab. 2004;89:2145–2149.
40. Erem C. Coagulation and fibrinolysis in thyroid dysfunction. Endocrinology.2009;36:110 –118.
41. Erem C, Ersoz HO, Karti SS, Ukinc K, Hacihasanoglu A, Deger O,Telatar M. Blood coagulation and fibrinolysis in patients with hyperthyroidism. J Endocrinol Invest. 2002;25:345–350.
42. Homoncik M, Gessl A, Ferlitsch A, Jilma B, Vierhapper H. Altered platelet plug formation in hyperthyroidism and hypothyroidism. J Clin Endocrinol Metab. 2007;92:3006 –3012. [PubMed]
43. Ostrander LD Jr, Brandt RL, Kjelsberg MO, Epstein FH. Electrocardiographic findings among the adult population of a total natural community, Tecumseh, Michigan. Circulation 1965;31:888–98.
44. Petersen P. Thromboembolic complications in atrial fibrillation. Stroke.1990;21:4 –13.
45. Heeringa J, Hoogendoorn EH, van der Deure WM, Hofman A, Peeters RP, Hop WC, et al. High-normal thyroid function and risk of atrial fibrillation: the Rotterdam study. Arch Intern Med 2008;168(20):2219–24.
46. Petersen P, Boysen G, Godtfredsen J, Andersen ED, Andersen B.Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation.The Copenhagen AFASAK Study. Lancet. 1989;1:175–179.
47. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE III. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24:35– 41.
48. Lee TH, Hsu WC, Chen CJ, Chen ST. Etiologic study of young ischemic stroke in Taiwan. Stroke. 2002;33:1950 –1955.
49. Putaala J, Metso AJ, Metso TM, Konkola N, Kraemer Y, Haapaniemi E, Kaste M, Tatlisumak T. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki Young Stroke Registry.Stroke. 2009;40:1195–1203. [PubMed]
50. Sheu JJ, Kang JH, Lin HC: Hyperthyroidism and risk of ischemic stroke in young adults: a 5-year follow-up study. Stroke 2010; 41: 961–966.Cardiology 2014;128:51-53. DOI: 10.1159/000357613. www.karger.com/crd
CITATION
DOI: 10.17511/ijmrr.2015.i1.21
Published: 2015-02-28
How to Cite
1.
Wawhal M, Mogal V, Dalvi V, Sanap S, Rathi A. Non Atrial Fibrillation related Central Retinal Artery Occlusion (CRAO) in Hyperthyroidism: A Case Report. Int J Med Res Rev [Internet]. 2015Feb.28 [cited 2024Jul.3];3(1):121-6. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/195
Section
Case Report
OAI - Open Archives Initiative
