April - June 2005, Volume 1, Issue 2

Ursu HI, Hortopan D, Podia-Igna C, Vizireanu A, Harsan T, Dumitriu L, Alexandrescu D

Late onset Graves thyrotoxicosis in a patient with 18 years history of euthyroid Graves ophtalmopathy

Acta Endo (Buc) 2005, 1 (2): 227-232
doi: 10.4183/aeb.2005.227

A 38 years old, heavy smoker, was admitted in our thyroid unit in August 1993 with left eye proptosis (21 mm), right eye prosthesis and euthyroidism. Orbital CT scan revealed inferior rectus muscle hypertrophy in the left orbit and possible residual (postoperative) lateral rectus muscle hypertrophy in the right orbit. Left eye proptosis was treated with both glucocorticoids and orbital radiotherapy.\r\nSeven years before (1986) the patient developed right eye proptosis, without clinical features of hyperthyroidism. Being suspected of a sphenoid ring meningioma and since orbital CT scan was not available at that time, a right orbit exploration was performed in November 1987; soon after orbital exploration, clinical features suggesting right orbital cellulitis occurred, followed by right eye evisceration and right eye prosthesis. After 18 years of Graves ophthalmopathy with euthyroidism, in February 2004 an autoimmune hyperthyroidism was diagnosed (suppressed TSH, high TT3, positive TRAb), being successfully treated with radioiodine. One year after the ablative therapy the patient is still euthyroid. A patient with euthyroid Graves ophthalmopathy should be monitored indefinitely, since a thyroid dysfunction may occur even after more than a decade.

Keywords: Graves ophthalmopathy, euthyroidism, orbital CT scan, radioiodine therapy

Correspondence: Horea Ursu, Institute of Endocrinology, 34 - 36 Bd Aviatorilor, Bucharest, Romania, e-mail: hursu@opensys.ro

References: