Mark Klimek Electrolytes and Endocrine Practice Test

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Graves’ disease commonly presents with what ocular finding and what is a key lab feature?

Ptosis; suppressed TSH with elevated free T4

Exophthalmos; suppressed TSH with elevated free T4

Graves disease causes autoimmune stimulation of the TSH receptor, leading to excess thyroid hormone and orbital inflammation. The ocular hallmark is exophthalmos, or proptosis, from swelling of the extraocular muscles and orbital fat. The most consistent lab feature is suppressed TSH with elevated free T4 (FT4), reflecting hyperthyroidism; FT3 may also be high.

So the best pairing is exophthalmos with low TSH and high FT4. Ptosis isn’t a typical Graves sign, conjunctival pallor isn’t relevant here, and retinopathy isn’t characteristic of Graves; an elevated TSH would point away from hyperthyroidism.

Conjunctival pallor; normal TSH

Retinopathy; elevated TSH