Thyroid Eye Disease – Graves Ophthalmopathy — SCE Neurology MCQ

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EasyNeuro-ophthalmologyThyroid Eye Disease – Graves OphthalmopathySCE Neurology

A 55-year-old woman presents with a 2-month history of unilateral left eyelid retraction, left proptosis, and left eye injection. She has restricted left eye movements, particularly upgaze. She also has hand tremor, tachycardia, and weight loss. Thyroid function tests show suppressed TSH and elevated free T4 and T3. What is the most likely cause of her eye signs?

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Correct answer: E — Thyroid eye disease (Graves ophthalmopathy)

Thyroid eye disease (Graves ophthalmopathy) is the most common cause of proptosis in adults. It is caused by autoimmune inflammation and lymphocytic infiltration of the extraocular muscles and orbital fat, associated with TSH receptor antibodies. Characteristic features include eyelid retraction (most common sign), proptosis, restricted eye movements (particularly upgaze — inferior rectus is most commonly affected), conjunctival injection, and periorbital oedema. The systemic features of hyperthyroidism (tremor, tachycardia, weight loss) with biochemical thyrotoxicosis confirm Graves disease. A: Cavernous sinus lesions cause ophthalmoplegia without proptosis. C: Orbital cellulitis has acute onset with pain and fever. D: MG causes ptosis, not lid retraction. E: Orbital lymphoma is painless without thyroid dysfunction.

Reference: NICE NG145 Thyroid Disease; EUGOGO Graves Ophthalmopathy Guidelines