Lacrimal gland enlargement as an early clinical or radiological sign in thyroid orbitopathy

PURPOSE: Characteristic ophthalmic signs of Thyroid Orbitopathy (TO) include exophthalmos, eyelid retraction, eyelid edema, restrictive extraocular myopathy, and optic neuropathy. In addition lacrimal gland (LG) enlargement can be observed in these patients. However TO has not usually been considered in the differential diagnosis of cases of isolated LG enlargement. OBSERVATIONS: A female patient at our institution (Texas Tech) was seen over a period from 2006 to 2012. This patient presented initially with LG enlargement as the primary clinical or radiologic sign of what later was diagnosed as TO. Computerized tomography and/or magnetic resonance imaging of the orbits were obtained and demonstrated isolated LG enlargement. CONCLUSIONS AND IMPORTANCE: This case represents, to our knowledge, the first report of LG enlargement as an initial presenting sign of TO. Further clinical and radiological studies looking at the natural history of TO would be useful to better understand the timing of LG involvement. In patients presenting with lacrimal gland enlargement, thyroid orbitopathy should be strongly considered in the differential diagnosis together with other causes of dacryoadenitis and LG tumors. This may save unnecessary and extensive diagnostic testing or even LG biopsies.