An Unusual Case of Optic Neuritis With Roth Spots in Hashimoto’s Thyroiditis

Thyroid-associated optic neuropathy (TAON) is an infrequent complication linked to autoimmune hypothyroidism.We present the clinical course of a 22-year-old female with a presumed case of TAON who presented with bilateral visual impairment and ocular pain.Clinical assessment revealed bilateral optic disc swelling, with the right eye exhibiting pronounced edema accompanied by peripapillary hemorrhages and Roth spots.Laboratory investigations confirmed elevated anti-thyroid peroxidase (anti-TPO) antibodies and deranged thyroid profiles, consistent with Hashimoto's thyroiditis.Magnetic resonance imaging (MRI) demonstrated subtle enhancement of the right optic nerve, without evidence of demyelinating brain lesions.Serological assessments for aquaporin-4 and myelin oligodendrocyte glycoprotein (MOG) antibodies were negative.Management involved a five-day course of intravenous methylprednisolone, followed by oral corticosteroids, alongside levothyroxine therapy.At one month, visual acuity in the left eye improved to 3/60, while the right eye remained without light perception.Disc edema and retinal hemorrhages resolved, with residual bilateral optic disc pallor.This case reports a rare entity of TAON along with the unusual occurrence of a Roth spot, presenting a diagnostic challenge.