1st April 2022

A 30-year-old female presents to her GP after friends and family have begun to comment that her eyes appear swollen

A 30-year-old female presents to her GP after friends and family have begun to comment that her eyes appear swollen. She says she has been feeling slightly more tired during the past few weeks but hadn’t thought much of it. She is a well-controlled type 1 diabetic with no other significant medical history. On examination, you clearly identify bilateral exophthalmos and when examining movement of the eyes, the patient experiences pain at extremities of movement. 

Blood tests of FBC, UEs, LFTs and thyroid function tests (TFTs) are requested, and all results are within the normal range except for the TFTs which are as follows:

• TSH: 0.4mU/L (0.5-5.0)
• Free T3: 8pmol/L (3.1-6.0)
• Free T4: 21.3pmol/L (11.0-21.0)

Select the SINGLE most likely diagnosis from the list below. Select ONE option only.