Thyroid eye disease

Case contributed by Dr Ian Bickle

Presentation

Graves disease. Proptosis Visual disturbance.

Patient Data

Age: 40 years
Gender: Male
MRI

Bilateral proptosis.

Bilateral enlargement of all extraocular muscles more evident in the medial, superior and inferior recti.  These enhance diffusely. The muscular enlargement is causing crowing of the optic nerve at the orbital apex.

The muscles show central enlargement with sparing of tendons with a 'coca-cola bottle' appearance.

No abnormal fat stranding.

Case Discussion

The typical appearances of advanced thyroid eye disease with the classical sequence of muscle enlargement (I'M SLOW) in this condition and the 'coca-cola' appearance of the muscles.

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