Hyperglobus and Pseudoptosis in Type 1 Lipogenic Thyroid Eye Disease

Area of Science:

• Ophthalmology
• Endocrinology

Background:

• Thyroid Eye Disease (TED) is an autoimmune condition affecting the orbits.
• Type 1 TED, or lipogenic TED, involves orbital fat expansion.

Observation:

• A male patient in his 50s presented with isolated left-sided eyelid drooping (pseudoptosis) and left hyperglobus.
• Initial examination and imaging revealed no signs of active inflammation, extraocular muscle enlargement, or orbital masses.
• Laboratory results indicated hyperthyroidism with suppressed TSH and elevated thyroid hormones, alongside positive thyroid-stimulating immunoglobulin (TSI).

Findings:

• The patient was diagnosed with Type 1 (lipogenic) TED presenting atypically.
• The primary manifestations were hyperglobus and pseudoptosis, attributed to orbital fat expansion.
• Classic TED indicators like contralateral eyelid retraction and significant extraocular muscle hypertrophy were absent.

Implications:

• This case underscores the heterogeneous presentation of Thyroid Eye Disease.
• It emphasizes the importance of considering TED in the differential diagnosis of pseudoptosis, even without other typical signs.
• Recognizing atypical TED presentations is crucial for timely diagnosis and management.