A Complicated Case of Thyroid
Eye Disease
Pg 31-36
Authors: B. Y. P. Chang, BSc, MBChB, FRCSEd, FRCOphth; R. Ajjan, FRCP, MMed.Sci,
PhD
Source: Endocrinology and Diabetes: Case Studies, Questions and Commentaries, R. Ajjan,
S.M. Orme (eds.), Springer-Verlag London 2015
Case: A 54-year-old with Type I Diabetes and Newly Diagnosed Thyrotoxicosis
A 54-year-old patient with type I diabetes for 30 years is referred to the endocrine clinic with
newly diagnosed thyrotoxicosis. The patient has been experiencing symptoms suggestive of
hyperthyroidism, such as heat intolerance, weight loss, anxiety, and palpitations, for at least
three months prior to the referral. Clinical examination reveals clear signs of
hyperthyroidism, including tachycardia (104/min/regular), hand tremor, lid lag, and sweaty
palms. The patient has a smooth uniform goiter upon neck palpation, and mild thyroid eye
disease (TED) is observed with a clinical activity score of 1/7. Thyroid function tests confirm
hyperthyroidism (FT4 64 pmol/l with TSH <0.05 mIU/L), and thyroid stimulating hormone
receptor antibodies are positive. The patient also has diabetes-related retinopathy but no other
complications or medical conditions.
Differential Diagnosis of Thyroid Eye Disease (TED) and Treatment for Eye Symptoms
TED is commonly misdiagnosed as allergic conjunctivitis. Other differential diagnoses to
consider include myasthenia gravis, orbital tumor/pseudotumor, carotid-cavernous fistula,
and orbital myositis. Given the patient's mild TED with a clinical activity score of 1/7
Eye Disease
Pg 31-36
Authors: B. Y. P. Chang, BSc, MBChB, FRCSEd, FRCOphth; R. Ajjan, FRCP, MMed.Sci,
PhD
Source: Endocrinology and Diabetes: Case Studies, Questions and Commentaries, R. Ajjan,
S.M. Orme (eds.), Springer-Verlag London 2015
Case: A 54-year-old with Type I Diabetes and Newly Diagnosed Thyrotoxicosis
A 54-year-old patient with type I diabetes for 30 years is referred to the endocrine clinic with
newly diagnosed thyrotoxicosis. The patient has been experiencing symptoms suggestive of
hyperthyroidism, such as heat intolerance, weight loss, anxiety, and palpitations, for at least
three months prior to the referral. Clinical examination reveals clear signs of
hyperthyroidism, including tachycardia (104/min/regular), hand tremor, lid lag, and sweaty
palms. The patient has a smooth uniform goiter upon neck palpation, and mild thyroid eye
disease (TED) is observed with a clinical activity score of 1/7. Thyroid function tests confirm
hyperthyroidism (FT4 64 pmol/l with TSH <0.05 mIU/L), and thyroid stimulating hormone
receptor antibodies are positive. The patient also has diabetes-related retinopathy but no other
complications or medical conditions.
Differential Diagnosis of Thyroid Eye Disease (TED) and Treatment for Eye Symptoms
TED is commonly misdiagnosed as allergic conjunctivitis. Other differential diagnoses to
consider include myasthenia gravis, orbital tumor/pseudotumor, carotid-cavernous fistula,
and orbital myositis. Given the patient's mild TED with a clinical activity score of 1/7
