Endocrine Abstracts

Introduction: Basedowian exophthalmos is an inflammatory disease of the orbit of autoimmune origin, potentially threatening with severe functional and psychosocial effects. It is usually accompanied by hyperthyroidism. It constitutes a real diagnostic challenge in patients with euthyroidism, as is the case with our patient.

Observation: A 34-year-old young woman with no particular pathological personal or family history. Who initially consults, a year ago, in ophthalmology for a unilateral, right, non-painful, hardly retractile exophthalmos, estimated at 27mm, and associated with ipsilateral palpebral retraction, without other signs, in particular inflammatory. The clinical activity score was 1. Faced with the unilateral character, an orbito-cerebral CT scan was performed, ruling out a tumor cause and confirming unilateral proptosis with slight infiltration of the periorbital muscles. It is oriented at our level for further exploration. The clinical examination does not find any clinical signs of hyperthyroidism or goiter. The thyroid balance was normal, namely TSH: 0.981 mui/ml, FT4: 15.67 pg/ml, TPOAb/TgAb negative, only positive TSH anti-receptors at 3.74. Thyroid ultrasound shows the appearance of lymphocytic thyroiditis. The patient received oral corticosteroid therapy which did not allow the regression of this proptosis, a cure of silicon was prescribed.

Discussion-Conclusion: Unilateral exophthalmos may be the only clinical manifestation of Graves’ disease in euthyroidism, thus posing a diagnostic challenge. And although the management of Basedowian exophthalmos is well codified, it still remains problematic in some patients.