Graves

Ons Maaoui; Sawsen Essayeh; Sabrine Mekni; Rihab Laamouri; Nadia Mchirgui; Karima Khiari; Imen Rojbi; Nacef Ibtissem Ben

doi:10.1530/endoabs.99.P590

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Endocrine Abstracts (2024) 99 P590 | DOI: 10.1530/endoabs.99.P590

ECE2024 Poster Presentations Late-Breaking (77 abstracts)

Graves’ orbitopathy: 40 years after diagnosis of graves’ disease

Ons Maaoui ¹ , Sawsen Essayeh ¹ , Sabrine Mekni ¹ , Rihab Laamouri ¹ , Nadia Mchirgui ¹ , Karima Khiari ¹ , Imen Rojbi ¹ & Ibtissem Ben Nacef ¹

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¹Charles Nicolle Hospital, Endocrinology

Introduction: Graves’ orbitopathy (GO) is an autoimmune inflammation of the orbital tissues and it’s the most frequent extrathyroidal complication of Graves’ disease (GD). It typically develops concomitantly with GD, but, it can also precede it or occurs secondarily. We report the case of a patient who presented with GO 40 years after the diagnosis of GD.

Case report: A 74-year-old patient with history of arterial hypertension, type 2 diabetes, total thyroidectomy 40 years ago for GD, was hospitalized in our department for severe GO. The ophthalmological examination of the right eye showed visual acuity of 3/10 with conjunctival hyperemia, and the left eye showed exophthalmos with eyelid innoclusion, conjunctival hyperemia, limited ocular motricity, inferior corneal opacity and superficial punctate keratitis. An orbital MRI was performed, showing a dysthyroid orbitopathy with inflammatory thickening and fatty infiltration of the oculomotor muscles, responsible for bilateral grade 3 exophthalmos and no signs of optic neuritis. The patient was put on general measures and intravenous corticosteroid therapy. The clinical outcome was favorable with regression of inflammation’s signs and improvement of visual acuity.

Conclusion: This case underlines the variable and often unpredictable nature of GO, and highlights the importance of vigilance for late-onset complications of GD and the need for ongoing monitoring even in patients with long-standing disease management.