SILENT THYROID, RARE BUT REAL. OCULAR MANIFESTATION OF EUTHYROID GRAVES EYE DISEASE, PERSPECTIVE OF OCULOPLASTIC CENTER.

Abstract

Background: Euthyroid Graves’ disease (EGD) is a rare manifestation of thyroid-associated ophthalmopathy (TAO) occurring in patients with normal thyroid function. While TAO is well-documented in hyperthyroid patients, the characteristics and progression of EGD remain under-researched due to its low prevalence. Delays in diagnosis are common as patients lack systemic thyroid symptoms, and its clinical presentation often overlaps with other orbital pathologies. Early recognition of EGD is critical to preventing vision-threatening complications and reducing morbidity.

Objective: To determine the clinical signs and demographic distribution of EGD in patients attending a tertiary oculoplastic service.

Methods: A cross-sectional study was conducted at the Oculoplastic Center of Medical Teaching Institute, Lady Reading Hospital, Peshawar, from January 2019 to December 2020. All consecutive patients diagnosed with EGD based on clinical and radiological findings and normal thyroid function tests were included. Data on demographics and clinical features were collected and analyzed using SPSS version 25. Frequencies and percentages were used for categorical variables, and mean ± standard deviation was calculated for continuous variables such as age. Chi-square and t-tests were applied where relevant, with a p-value of <0.05 considered statistically significant.

Results: Out of 48 patients enrolled, 31 (63.3%) were female and 17 (36.7%) male. The majority, 30 patients (61.2%), were over 51 years old. Eyelid retraction was the most common sign, seen in 21 females (42.9%) and 10 males (20.4%). Eyelid swelling was noted in 13 females (26.5%) and 9 males (18.4%). Proptosis was more prevalent in males. In the >51 age group, 18 patients (38.7%) presented with eyelid retraction, followed by 12 (24.5%) with eyelid swelling. Optic neuropathy was identified in 4 cases (8.2%).

Conclusion: Upper eyelid retraction was the most frequent clinical sign in EGD, particularly in older females. Serious complications like optic neuropathy and myopathy underscore the importance of early identification and multidisciplinary management in euthyroid patients presenting with orbital symptoms.