thyroid tests
(1). Thyroid function tests (Table 1) were surprisingly normal with a normal Total T4, Free T4, Total T3. and serum TSH. Thyroid auto-antibodies were negative but remarkably the TRAb test was very high (76% and 81%; normal up to 10%). This indicates that anti-TSH receptor activity is present in spite of removal of most of her thyroid gland. Possibly lymph nodes metastasis and lung metastasis (not confirmed yet) could be the source of serum T4 and T3 in this patient.
The orbital CAT-scan (without contrast) confirmed the presence of enlarged extra ocular muscles as well as excessive fat/fibrous tissues in the retro orbital space, and ruled out the unlikely possibility of metastasis. Taken together with the clinical score it may be suggestive of active Thyroid Associated Ophthalmopathy. (TAO)