Concurrent occurrence of thyroid-associated orbitopathy and idiopathic orbital inflammatory diseases

Background: The coexistence of thyroid-associated orbitopathy (TAO) and idiopathic orbital inflammatory diseases (IOID) is rare. They mimic each other clinically, and it is challenging to differentiate the two. We are presenting a case of bilateral proptosis resulting from concomitant TAO and IOID. Case Report: A 44-year-old female presented with swelling, pain, and protrusion of both eyes for one month. She had a past history of trauma in the right eye (RE) 15 years ago. Her best-corrected visual acuity in RE was hand movements and 20/30 in the left eye (LE). There was lid edema, conjunctival congestion, chemosis with axial proptosis, and restricted extraocular movements in both eyes (BE). The anterior segment of RE revealed sequels of old anterior traumatic uveitis and it was normal in the LE. The B scan done in BE showed enlargement of all extraocular (EOM). CT scan orbit showed enlargement of all the EOM belly and tendon insertions. Thyroid profile found to have high anti-TPO (thyroid peroxidase) suggestive of Hashimoto's thyroiditis. The patient was started on intravenous methylprednisolone and showed significant improvement. Conclusion: TAO and IOID can present together. This case report highlights the need for clinicians to be aware of this condition.