Case Study 54 Myositis and Graves’ Disease

Abstract

DH is a 55-year-old man who was diagnosed with acute inflammatory myositis of his right superior rectus muscle based on CT scan findings of thickening of that muscle with other extraocular muscles (EOMs) appearing of normal thickness. His initial symptoms of pain and marked swelling were greatly relieved by high-dose prednisone treatment. However, he continued to have signs of orbital congestion with some degree of exophthalmos. Echography was obtained and the other extraocular muscles were measured to be of thickness greater than the upper limits of normal on a nomogram. Their internal reflectivity on A-scan was consistent with Graves’ disease. The internal spikes were medium-to-high reflective (Fig. 1). His thyroid workup found a borderline low TSH with the presence of antithyroid antibodies. He was referred for management of the thyroid to his internist. His ophthalmologist followed his ocular status with a plan for radiation therapy or decompressive surgery if his Graves’ orbitopathy worsened.