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Neonatal Graves' disease
C L Shields1, L B Nelson, G C Carpenter
1Pediatric Ophthalmology Service, Wills Eye Hospital, Philadelphia, PA 19107.
Insights
Neonatal Graves' ophthalmopathy can mimic other conditions like optic nerve gliomas. This case highlights the importance of considering maternal thyroid disease in infant eye proptosis.
Area of Science:
- Ophthalmology
- Endocrinology
- Pediatrics
Background:
- A 7-month-old boy presented with unilateral proptosis, initially suspected to be optic nerve gliomas based on CT findings.
- The infant's mother had clinical hyperthyroidism, prompting further investigation into potential endocrine causes for the child's condition.
Observation:
- Clinical examination revealed pseudoproptosis due to left upper eyelid retraction, not true exophthalmos.
- Magnetic resonance imaging confirmed normal orbital structures, ruling out optic nerve gliomas.
Findings:
- The infant, despite being euthyroid, was diagnosed with neonatal Graves' ophthalmopathy.
- The mother's hyperthyroidism was confirmed by abnormal thyroid function tests.
Implications:
- This case underscores the importance of a thorough maternal and infant medical history in diagnosing pediatric eye conditions.
- Neonatal Graves' ophthalmopathy requires careful observation and management, distinct from surgical or oncological interventions for conditions like optic nerve gliomas.
Abstract:
A newborn boy was noted by his mother to have a prominent left eye at birth, but an eye examination was delayed until age 7 months, at which time his ophthalmologist diagnosed exophthalmos. Computed tomography was interpreted as showing mild, diffuse, optic nerve thickening bilaterally suggestive of optic nerve gliomas. Subsequent examination in our clinic revealed pseudoproptosis secondary to retraction of the left upper eyelid. Magnetic resonance imaging demonstrated normal orbital structures. The mother was noted to be clinically hyperthyroid, and abnormal thyroid function tests confirmed the diagnosis. Although the infant was euthyroid, neonatal Graves' ophthalmopathy was diagnosed. He was managed by close observation while his mother was treated for her hyperthyroidism.