Case Report A Case of Unilateral Euthyroid Graves’ Disease

Unilateral proptosis and ptosis in euthyroid Graves’s disease is very rare with 5 -10% cases reported. We present a clinically Euthyroid male with features of thyroid ophthalmopathy who presented with unilateral proptosis and ptosis, restriction of extra ocular movements and compressive optic neuropathy. Thyroid function tests were normal and anti-thyroid peroxidase antibody was positive. CT scan revealed extraocular muscle thickening sparing the tendons. He was treated with systemic steroids for 8 weeks. Subsequently, symptoms gradually recurred and there was no improvement in vision. He was referred for orbital decompression. It is to be emphasized that any patient with unilateral proptosis and ptosis should be evaluated for thyroid eye disease and should be screened for anti-thyroid antibodies if thyroid function tests are normal. Early diagnosis and prompt treatment of ophthalmopathy with systemic corticosteroids can prevent vision threatening complications. This case intends to highlight that unilateral proptosis and ptosis may be the presenting features of euthyroid Graves’ disease, and is a diagnostic challenge, with important consequences, as lack of timely treatment of Graves’' disease can aggravate visual morbidity.