Concurrent Graves’ Ophthalmopathy and Sjögren’s Syndrome: A Case Report
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- Sjögren’s syndrome, Graves’ ophthalmopathy, graves orbitopathy, Thyroid eye disease, autoimmune ocular disease
Abstract
Graves’ ophthalmopathy (GO) is the most common extrathyroidal manifestation of Graves’ disease, while Sjögren’s syndrome (SS) is a systemic autoimmune disease characterized by exocrine gland dysfunction. Although both conditions share autoimmune mechanisms, their coexistence remains underrecognized. We report a case of a woman presenting with progressive bilateral proptosis, ocular discomfort, xerophthalmia, and xerostomia. Ophthalmologic examination revealed bilateral proptosis with preserved visual acuity and normal intraocular pressure. Thyroid function tests demonstrated suppressed thyroid-stimulating hormone (TSH) and elevated free thyroxine (FT4), while orbital imaging showed bilateral extraocular muscle enlargement and exophthalmos, supporting the diagnosis of Graves’ ophthalmopathy. In addition, severe dry eye symptoms, reduced Schirmer test values, and xerostomia raised suspicion of coexisting Sjögren’s syndrome overlap. The patient demonstrated gradual clinical improvement following multidisciplinary management and systemic therapy. This case highlights the diagnostic challenge posed by overlapping ocular manifestations, particularly dual-mechanism dry eye resulting from both exposure-related and aqueous-deficient mechanisms. Early recognition of autoimmune overlap conditions is essential to optimize diagnosis, multidisciplinary management, and long-term outcomes.
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Copyright (c) 2026 Banu Aji Dibyasakti, Nikolaus Erik Darmawan, Safirah Khairuna
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