Proptosis as First Presentation of Graves' Disease

Graves' disease is usually diagnosed as a syndrome of clinical and biochemical features including ophthalmopathy (TAO); the latter occurring in up to 50% of patients with the syndrome. The incidence of TAO is higher in females than in males, as with the parent syndrome (16:2.9 cases per 100 000 people annually). Onset is later in males, who also tend to have more severe cases and poorer prognosis. A 34 year-old male patient initially presented at the Eye Clinic with a three-month history of right-sided proptosis. Main findings were right proptosis of 3 mm, with no lid retraction or lag, nor impairment of vision. He was subsequently referred to the Endocrinology Clinic; there he was diagnosed with Graves' disease and placed on antithyroid medication. Ocular manifestations may be the first signs of Graves' disease, as occurred with this patient.