Case presentation A 60-year-old woman was referred to the endocrinology division by her ophthalmologist due to abnormal thyroid tests. She was on oral prednisone 20 mg twice daily as per her ophthalmologist’s recommendation. Her chief complaint for the past several weeks was bilateral eye pain and photophobia. She was symptomatic with occasional palpitations and mild shortness of breath.
Physical examination Her blood pressure was elevated to 152/88 mmHg, and h eart rate was 80 bpm. Bilateral exophthalmos and an enlarged thyroid gland were noted. Laboratory tests TSH: 0.009 mIU/mL Free Thyroxine (FT4): 4.59 ng/dL T3: 231 ng/dL TSH Receptor Autoantibodies (TRAb): Positive with a value of 48.5% Thyroid Stimulating Immunoglobulin (TSI): Positive with a value of 458% ALT level: 112 U/L Thyroid ultrasound (Image on Left): The thyroid ultrasound showed a mildly enlarged gland. The right…
