SHM Converge Scientific Abstract ePoster Gallery-Euthyroid Graves' Opthalmology

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This case describes a 41-year-old female smoker who developed progressive dry eyes, blurry vision, right eye bulging, pain, and diplopia over three months, without symptoms of thyroid dysfunction. Examination showed right proptosis, upper eyelid retraction, mild redness, and tearing, with mild proptosis on the left. Her thyroid exam was normal.<br /><br />Laboratory testing revealed markedly elevated thyroid-stimulating immunoglobulin (TSI) and TSH receptor antibodies (TRAb), but normal TSH, free T4, and T3, confirming a euthyroid state. Orbital imaging showed enlargement and inflammatory changes in the extraocular muscles, especially on the right. Although MRI findings initially suggested idiopathic orbital inflammation, the elevated thyroid antibodies and clinical picture supported euthyroid Graves’ ophthalmopathy.<br /><br />She was treated with a prolonged high-dose prednisone taper over two months, which improved her symptoms. She was also counseled to stop smoking, since cigarette smoking increases the risk and severity of Graves’ ophthalmopathy. She has remained clinically and biochemically euthyroid since diagnosis.<br /><br />The report highlights that Graves’ ophthalmopathy can occur even in patients without overt thyroid disease, sometimes preceding thyroid dysfunction. Treatment options are generally the same as in Graves’ disease.

Asset Subtitle

Syed Muhammad Hussain Zaidi

Meta Tag

Author List Apeksha Kakkar, Sandeep Mandal, Sarasija Natarajan, Syed Muhammad Hussain Zaidi

Category Clinical Vignettes

Concept Graves Disease

Concept Euthyroidism

Concept Thyroid-Stimulating Immunoglobulin

Concept TSH Receptor Antibody

Concept Extraocular Muscle Enlargement

Distinguished Non-Finalist

Presenter Organization Wright Center for GME

Presenting Author Syed Muhammad Hussain Zaidi

Track Adult

Keywords

euthyroid Graves ophthalmopathy

thyroid-stimulating immunoglobulin

TSH receptor antibodies

proptosis

diplopia

smoking risk

extraocular muscle enlargement

orbital inflammation

prednisone taper

dry eyes

Graves Disease

Euthyroidism

Thyroid-Stimulating Immunoglobulin

TSH Receptor Antibody

Extraocular Muscle Enlargement