Graves' ophthalmopathy, also called Graves' orbitopathy, is a potentially sight-threatening ocular disease that has puzzled physicians and scientists for nearly two centuries. Generally occurring in patients with hyperthyroidism or a history of hyperthyroidism due to Graves' disease, Graves' ophthalmopathy is also known as thyroid-associated ophthalmopathy or thyroid eye disease, because it sometimes occurs in patients with euthyroid or hypothyroid chronic autoimmune thyroiditis. The condition has an annual adjusted incidence rate of 16 women and 3 men per 100,000 population.
Our patient, a 55 year old male had severe internal deviation of right eye and symptoms of diplppia, grittiness, epiphora in both eyes for last 6 years. He was seen for these eye signs for 6 years by many ophthalmologists and neurologists. He was subjected to brain imaging twice with one contrast enhanced CT and MRI brain reported as normal. Patient was referred to us 1 month back, when in addition to his eye deviation and evidence of activity, he had GII goiter. On further questioning patient gave history suggestive of hyperadrenergic state and had features of thyrotoxicosis. Thyroid function test, RAIU and thyroid scan was suggestive of diffuse toxic goiter of Grave's origin. Review of MRI showed normal brain parenchyma but hypertrophy of medial recti and inferior obliques (more on right side). Patient was treated with methmizole, b-blockers and was referred to neuropthalmologist for possible corrective surgery.
Figure 1.
Severe internal deviation of right eye with conjunctival congestion in both eyes
Figure 2.
Goiter GI with the opthalmopathy (Median deviation of right eye and chemosis and conjunctival congestion in both eyes.