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Images of Memorable Cases: Case 93

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

http://rup.rice.edu/memcases-button.jpg

Case_93-pres1-1.jpg

93. Unilateral thyrotoxic exophthalmos

This 42-year-old man presented with heat intolerance, nervousness, and a 20-lb weight loss of six months’ duration. As shown in the image, he had obvious left-sided proptosis and a striking, hawk- like stare bilaterally. He also had visible and palpable enlargement of his thyroid gland, especially the isthmus and right lobe. Laboratory studies confirmed the clinical diagnosis of hyperthyroidism. With radioiodine therapy, the patient became asymptomatic, his thyromegaly resolved, and his exophthalmos all but disappeared.

Two points here deserve emphasis: 1) a prominent stare as seen in this patient should always bring to mind hyperthyroidism; and 2) hyperthyroidism deserves consideration in every patient with unilateral exophthalmos.

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