Aomatsu Keiichi, Kusaka Shunji
Department of Ophthalmology, Nara Hospital, Kindai University Faculty of Medicine, Nara, Japan.
Department of Ophthalmology, Kindai University Faculty of Medicine, Osaka, Japan.
Case Rep Ophthalmol Med. 2020 Nov 1;2020:8829655. doi: 10.1155/2020/8829655. eCollection 2020.
To report a case of isolated superior oblique muscle swelling causing acute vertical strabismus in Graves' disease.
A 26-year-old woman with a 1-month history of misalignment of the right eye and diplopia was referred to us. Her visual acuity and intraocular pressures were normal in both eyes, but eye movement tests showed clear misalignment of her right eye. Antibody tests for myasthenia gravis were negative. However, blood tests revealed abnormal levels of thyroid-related factors, such as decreased thyroid-stimulating hormone, elevated free T3 and T4, and elevated anti-thyroid-stimulating hormone receptor antibody. We performed magnetic resonance imaging (MRI), which showed slight enlargement of the left superior oblique muscle. The patient was eventually diagnosed with Graves' disease with superior oblique muscle involvement and underwent a thyroidectomy. Three months postoperatively, her diplopia and abnormal eye movements had substantially resolved.
Isolated superior oblique muscle involvement may be a presenting symptom of Graves' disease. It should be taken into consideration that, in the early stages of thyroid-associated ophthalmopathy (TAO) in adults, only the superior oblique muscle may be enlarged.
报告1例因孤立性上斜肌肿胀导致Graves病急性垂直斜视的病例。
一名26岁女性，有右眼斜视和复视1个月病史，前来我院就诊。她双眼视力和眼压正常，但眼球运动检查显示右眼明显斜视。重症肌无力抗体检测为阴性。然而，血液检查显示甲状腺相关因子水平异常，如促甲状腺激素降低、游离T3和T4升高以及抗促甲状腺激素受体抗体升高。我们进行了磁共振成像（MRI）检查，结果显示左上方斜肌轻度肿大。该患者最终被诊断为累及上斜肌的Graves病，并接受了甲状腺切除术。术后3个月，她的复视和异常眼球运动基本消失。
孤立性上斜肌受累可能是Graves病的首发症状。应考虑到，在成人甲状腺相关性眼病（TAO）的早期阶段，可能仅上斜肌肿大。
