Endocrine Abstracts

JOINT3526

Introduction: Grave’s orbitopathy (GO) is an autoimmune disorder most commonly associated with Graves’ disease (GD). It is typically manifested by exophthalmos, chemosis, and palpebral retraction. We report the case of a patient with GO presenting without exophthalmos and with normal MRI findings.

Observation: A 25-year-old female patient was referred for further management of GO. Hyperthyroidism was diagnosed in the presence of diplopia. The initial ophthalmological examination revealed partial paralysis of the medial branch of cranial nerve III, ptosis, and paralysis of the right superior rectus muscle, without exophthalmos. Initial cerebro-orbital MRI was unremarkable, showing intact oculomotor muscles and normal appearance of the optic nerves and chiasm. The initial thyroid function tests revealed FT4 at 68 pmol/l (reference range: 13-24 pmol/l) and TSH <0.01 mU/l (reference range: 0.5-5 mU/l). The patient was started on methimazole and oral corticosteroids. However, there was no improvement in the ophthalmological examination. A second cerebro-orbital MRI showed hypertrophy and inflammation of the inferior right oculomotor muscle, with T2 hyperintensity, T1 isointensity, and strong enhancement following gadolinium administration. The patient received three doses of methylprednisolone (1 g daily for three consecutive days), with a marked improvement in her diplopia at the two-week follow-up.

Conclusion: This case highlights the diagnostic challenges of GO, which may mimic other conditions and present in atypical forms. It should be considered in any patient with an oculomotor abnormality, particularly in young women. Repeated imaging is recommended even when initial imaging results are normal.