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G.H. Hanselmayer, G. Schild, B. Fueger, A. Hofmann, G. Schmidinger, J. Nepp, G. Zettinig; Increased Prevalence of Abnormal Lacrimal Gland Function Tests in Patients with Hashimoto's Thyroiditis: A Cross Sectional Study . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2468.
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Purpose: Hashimoto's thyroiditis (HT) is associated with a variety of autoimmune diseases, but the association with lacrimal gland function impairment is not well determined. The aim of this study was to evaluate the prevalence of abnormal lacrimal function tests in patients with autoimmune thyroiditis Hashimoto. Methods: We investigated 96 eyes of 48 patients with HT (mean age 52±13 years, range 23-79 years), and compared them to a sex- and age-matched control group (n=38). All patients had their free circulating thyroxine (fT4) and their free circulating triiodthyronine (fT3) hormone levels within the normal range (1.37 ± 0.37 ng/dl and 2.21 ± 0.78 pg/ml, respectively). HT was diagnosed on the basis of elevated levels of autoantibodies to antithyroid peroxidase (TPO-Ab) and hypoechogenic thyroid tissue in the sonography. Lacrimal gland function was evaluated with three different objective tests and a detailed ophthalmological anamnesis and was compared to the findings in the controls. Patients with additional factors known to affect lacrimal gland function such as contact lenses or history of radiation exposure were excluded from the study. Results: A total of 45 patients (90%) had at least one abnormal objective test indicating impaired lacrimal gland function. Abnormal Schirmer's tear test results (<10mm/5min) were significantly more prevalent in the study group (50% vs. 21%; p<0.001). Abnormal lacrimal lipid layer tests were also significantly more frequent in the patients group (73% vs. 11%; p<0.0001). However, the prevalence of abnormal tear film break up time (<5sec) did not differ significantly between both groups (38% vs. 34%; p=0.75). In addition, the mean values of the lacrimal function tests differed significantly between patients and controls: Schirmer's tear test: 15.6 mm/5min vs. 21.2 mm/5min; p<0.01. Lipid layer interference: p<0.001. Break up time: 8.61 sec vs. 9.88 sec; p<0.05. Conclusions: Our findings demonstrate that in patients with autoimmune thyroiditis Hashimoto, lacrimal function is significantly impaired. All three layers of the tear film are involved and there is a pronounced effect on the lipid layer.
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