A Case of Third Cranial Nerve Palsy Accompanying Thyroid Eye Disease

Abstract

Purpose: To report a patient who developed thyroid eye disease and third cranial nerve palsy at the same time and showed good response to high dose steroid therapy.Case summary: A 50-year-old woman who was diagnosed with Graves' disease presented with binocular vertical diplopia for 1 month. Diplopia was persistent and did not show any fluctuation daily. Up gaze was limited in the right eye. Orbital computed tomography showed hypertrophy of the inferior rectus muscles in both eyes. After 12 days, she complained of rapid progression of diplopia. Adduction and down gaze were limited in the left eye, and left hypertropia and exotropia were presented. Steroid pulse therapy was administered, and eye movements and strabismus improved at one month after treatment, and there were no recurrences until 9 months after symptom onset.Conclusions: Thyroid eye disease was accompanied by third cranial nerve palsy. If ocular movement is not consistent with the extraocular muscle involved or the forced duction test result in thyroid eye disease, the possibility of combined cranial nerve palsy should be considered.