Graves' orbitopathy and the thyrotropin-releasing hormone (TRH) test

The value of the thyrotropin-releasing hormone (TRH) test may be insufficiently emphasized in the diagnosis of patients with euthyroid Graves' disease who have unexplained proptosis or vertical diplopia. We saw three patients who had these orbital symptoms and normal routine serum thyroid studies. The orbital computed tomograms (CT) found an orbital myopathy in all, and the diagnosis of Graves' orbitopathy was made by an abnormal TRH test. Not all euthyroid Graves' patients will show a positive result, but in those who do, the test is diagnostic. The clinical summaries of our three patients and the applications of the thyrotropin-releasing hormone test in ophthalmic practice are reviewed.