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A difficult diagnosis: severe Graves' ophthalmolopathy.
Ivan Yeu Ming Yip1, Fizza Mushtaq2, Tristan Reuser2
1Department of Ophthalmology, Heart of England NHS Trust, Birmingham, UK.
BMJ Case Reports
|March 11, 2015
Summary
This case report details a severe thyroid eye disease presentation in an elderly woman. Prompt steroid treatment effectively managed intense inflammation and eye movement restriction.
Area of Science:
- Ophthalmology
- Endocrinology
- Internal Medicine
Background:
- Elderly patient with atrial fibrillation, on warfarin, and hyperthyroidism presented with acute proptosis and restricted eye movements.
- Initial differential diagnosis included intracranial pathology due to the rapid onset and severity of symptoms.
Observation:
- Ophthalmological examination revealed severe inflammation consistent with thyroid eye disease.
- The patient experienced significantly restricted movement in her left eye.
Findings:
- Diagnosis of severe thyroid eye disease was confirmed after excluding intracranial causes.
- Systemic steroid therapy led to a positive clinical response, reducing inflammation and improving eye mobility.
Implications:
- This case underscores the importance of considering thyroid eye disease in elderly patients with comorbidities presenting with acute ophthalmological symptoms.
- Highlights diagnostic challenges posed by multiple health conditions in older adults.
- Emphasizes the efficacy of systemic corticosteroids in managing severe, rapidly progressing thyroid eye disease.
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