BMJ Case Reports 2013; doi:10.1136/bcr-2012-007485
  • Unusual association of diseases/symptoms

Asymmetric graves ophthalmopathy as a sole manifestation of autoimmune hypothyroidism

  1. Shailesh Kumar Singh3
  1. 1Department of Internal Medicine, CSM Medical University, Lucknow, Uttar Pradesh, India
  2. 2Department of Medicine, CSM Medical University, Lucknow, Uttar Pradesh, India
  3. 3Department of Radiodiagnosis, CSM Medical University, Lucknow, Uttar Pradesh, India
  1. Correspondence to Dr Sudhir Kumar Verma, sudhirkgmu{at}


Graves ophthalmopathy (GO) is commonly associated with hyperthyroidism, however its coexistence with hypothyroidism is seen uncommonly in 5% of cases. The ophthalmic signs in GO are usually bilaterally symmetrical, however in 10–15% of cases patients may present asymmetrically. The ophthalmic signs in GO are commonly seen with other systemic features of thyroid disease, however when a patient present with asymmetric ophthalmic signs in the absence of other thyroid manifestations, it is difficult to consider the possibility of thyroid disorder, which may result in delayed diagnosis and further progression of disease. Here, we report a case of 22-year-old man who presented with progressive painless bulging of right eye without other features of thyroid disease which on workup was diagnosed as a case of autoimmune hypothyroidism.

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