Endocrine Abstracts

JOINT3552

Introduction: Thyroid associated orbitopathy (TAO) or graves disease is an autoimmune disorder associated with hyperthyroidism. Most common presentation is eyelid retraction followed by exophthalmos. Although it is associated with myasthenia gravis, it is a relatively uncommon cause of ptosis. We report a case of young adult woman who presented with unilateral ptosis in right eye revealing a graves disease.

Case Report: A 26-year-old female presented with a history of weight loss, panic attacks, palpitations and muscle weakness for 2 months. She had no history of thyroid affection. She complained of dropping of her right eyelid, which was insidious in onset and gradually progressive. Laboratory investigations revealed a hyperthyroidism; the free T3 level was 36.27 pmol/l (reference range: 3.10–6.80), free T4 level was 100 pmol/l (reference range: 12.0–22.0), TSH was 0.008 mIU/l (reference range: 0.27–4.20), and TSH receptor antibody (TRAb) was 6.49IU/l (reference range <1). She was diagnosed with Graves disease and started on intravenous methylprednisolone 120 mg followed by 3 days of 60 mg then 40 mg of Carbimazole.

Discussion: The relationship of muscle size to motility deficit using muscle diameter measurements on CT scans of patients with Thyroid Eye Disease(TED) was studied. There are several mechanisms of ptosis that have been reported in association with TED. Pathologic and radiographic studies revealed that although the inferior rectus is most commonly involved, every extraocular muscle, including the levator palpebrae, can be affected. The immunology of dysthyroid eye disease still complex. This case suggests that TED can significantly affect any muscle in the orbit, causing many unique symptoms and clinical presentations.