International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2013): 6.14 | Impact Factor (2014): 5.611 Volume 4 Issue 10, October 2015 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Euthyroid Ophthalmopathy: A Rare Case Report and a Brief Review of Literature Dr. Mahendra Wawhal 1 , Dr. Vajed Mogal 2 , Dr. Pratik Patil 3 , Dr. Preetam Ahire 4 , Dr. Sushant Yadav 5 1 Associate Professor and Consultant (M.D. Medicine), 2 Senior Resident, 3,4,5 Junior Resident, all are in department of medicine, M.G.M. Medical college and Hospital, Aurangabad-431003, Maharashtra, India Abstract: Thyroid-associated ophthalmopathy usually occurs in a close temporal relationship with hyperthyroidism. It is rare in patients with normal thyroid function (euthyroid ophthalmopathy) and in patients with hypothyroid forms of thyroid autoimmune disease (hypothyroid ophthalmopathy) 1 . A 43-year-old male, known case of hypertension presented with involuntary jerky movements and protrusion of eyes since 2 months with normal thyroid functions, diagnosed to have euthyroid opthalmopathy & responded very well to steroids. It is currently believed that euthyroid ophthalmopathy reflects the underlying autoimmune process and it is not a consequence of alternations in thyroid function 2 . Keywords: Euthyroid, Thyroid eye disease (TED), Thyroid-associated ophthalmopathy (TAO), TSH receptor antibodies (TRAb). 1. Introduction Euthyroid Graves' disease is an autoimmune condition that causes the characteristic eye symptoms of Graves' ophtalmopathy, which is more commonly known as thyroid eye disease (TED), in the absence of thyroid dysfunction. Most patients with euthyroid Graves' disease go on to develop thyroid disease within 12-18 months after eye symptoms develop. Most of these patients develop Graves' disease, an autoimmune thyroid disorder, although a smaller number of patients may develop autoimmune hypothyroidism 3 . Thyroid-associated ophthalmopathy (TAO), frequently termed Graves ophthalmopathy, is part of an autoimmune process that can affect the orbital and periorbital tissue, the thyroid gland, and, rarely, the pretibial skin or digits (thyroid acropachy) 4 . Graves ‘ophthalmopathy is the most common orbital disease and affects 25-50% of the patients with Graves’ disease. It`s more common in females, between the second and fifth life`s decade. The disease has an acute and a chronic stage, slowly progressing until it stabilizes, with rare cases of spontaneous resolution. The treatment depends on the stage and the disease is mainly treated with oral or intravenous corticosteroids with or without radiotherapy 5 . Here, we present a rare case where there is severe Anti-TPO related autoimmune opththalmopathy in a euthyroid patient. 2. Case Report A 43-years-old male, presented with the chief complaints of involuntary jerky movements and protrusion of eyes (fig:1) since past 2 months. He was treated by local doctor, and artificial tears and eye ointments were prescribed for his symptoms. There was no associated ocular motility disorder or doubling of vision or postural variations. The patient denies for any loss of weight in spite of good appetite, sweating, tremor or palpitation. There was no history of any trauma. There is no preceding history of defective vision or blackouts or transient loss of vision or defective color perception. The patient also denies for any skin discoloration or any neck swelling or exposure to radiation therapy or chemotherapy. There was no history of dysphagia, dysphonia, easy fatigability. The patient was non diabetic. He is a known case of hypertension and hypercholestrolenemia controlled on Tab. Telmisartan 40mg and Tab. Stator 40mg. The family history was without any significance. On examination, he was averagely built and well nourished. Sleeping pulse rate 86 per minute, regular in rhythm and volume. Blood pressure 140/90 mm Hg in right upper arm in supine position. No evidence of cyanosis, clubbing, lymphadenopathy, oedema , and pallor was seen. Higher functions were normal. Systemic examinations were within normal limits. Fundus examination and eye movements were normal. On opthalmological examination patient had eyelid retraction. Upper eyelid retraction. This finding is associated with lid lag on infraduction (Von Graefe's sign), eye globe lag on supraduction (Kocher's sign), a widened palpebral fissure during fixation (Dalrymple's sign) and an incapacity of closing the eyelids completely. Figure 1 Routine investigations including hemogram (Hb-15gm/dl, TLC-7500/cumm, Platelet count-147,000/cumm), liver function tests and kidney function tests & serum electrolytes were normal. Lipid profile showed serum Paper ID: SUB158699 529