Endocrine Abstracts

Introduction: Graves’ disease is a multi-system autoimmune disease characterized by hyperthyroidism, ophthalmopathy and pretibial myxedema. The disease presents with hyperthyroidism or more rarely with ophthalmopathy. It runs a various course and many times during its natural course permanent hypothyroidism may ensue.

Aim: The aim was to describe the case of a patient with Graves’ disease presenting with ophthalmopathy and subclinical hypothyroidism.

Case description: A patient, female, aged 59 years, presented with proptosis of the right eye and other symptoms such as a sense of foreign body within the eyes. A CT scan of the orbits was performed which showed increased volume of the extraocular muscles of both eyes, which was prominent in the right eye. A laboratory evaluation showed TSH receptor antibodies marginally positive 1.7 IU/l (normal values <1.5 IU/l), positive microsomal and antithyroglobulin antibodies, TSH 4.9 mIU/l and FT₄ normal. Methylprednisolone was administered 500 mg/wk iv for a period of 6 weeks followed by tapering of prednisolone orally. The proptosis of the right eye improved. A new laboratory evaluation showed TSH 5.7 mIU/l. Thyroxine was administered at a dose of 75 μg daily. The patient is stable and euthyroid, TSH being 2.1 mIU/l on thyroxine and low dose prednisolone.

Conclusions: The case of a patient with Graves’ disease is described which presented with ophthalmopathy and subclinical hypothyroidism. In Graves’ disease permanent hypothyroidism may develop over the course of the disease. However, presentation of the disease with subclinical hypothyroidism is very rare and underlines the relationship, as far as pathogenesis and pathophysiology is concerned, between autoimmune Hashimoto thyroiditis which causes hypothyroidism and Graves’ disease, a multi-system autoimmune disease characterized by multiple organ system involvement and hyperthyroidism.