MON-436 Understanding The Mass Effect, Chronic Grave’s Ophthalmopathy Improvement After Significant BMI Reduction

Abstract Disclosure: Z. Roe-Zurz: None. L. Madrigal: None. Graves’ ophthalmopathy (GO) is a serious complication of autoimmune hyperthyroidism, affecting approximately 30% of patients. It is characterized by immune-mediated inflammation of retro-orbital tissues, which can lead to sight-threatening complications. Recent evidence suggests that obesity and related metabolic factors—including hyperinsulinemia, insulin resistance (HOMA-IR), and elevated high-sensitivity C-reactive protein (hs-CRP)—are associated with both the presence and severity of GO. Here, we present a case of chronic GO that significantly improved following BMI reduction after sleeve gastrectomy. A 49-year-old woman with class III obesity and a complex thyroid disease history—including Graves’ ophthalmopathy (GO) previously managed with orbital decompression and lid surgery in 2012, as well as papillary thyroid carcinoma status post-thyroidectomy with post-ablative hypothyroidism—presented in the Fall of 2023 with progressive frontal headaches, orbital pain, and upward gaze diplopia. Examination revealed proptosis, lateral lid fullness, and 1+ scleral show. Hertel ophthalmometry, which measures the distance between the corneal apex and lateral orbital rim, showed slight, but objective, progression to 25/25 mm at a 105 mm base. Orbital CT demonstrated asymmetric enlargement of the medial and inferior rectus muscles with bilateral proptosis. Her TSH and free T4 were within normal limits, and thyroglobulin antibodies were undetectable.Despite multiple obesity therapies, including daily liraglutide, her ocular symptoms worsened over several months. She was referred for bariatric surgery, and following a postoperative BMI reduction from 35 to 30, her ocular symptoms rapidly improved. Hertel measurements returned to baseline at 23/23 mm and later improved further to 17/17 mm at a 105 mm base.Understanding how obesity and its associated factors—particularly its pro-inflammatory state—influence the pathophysiology and progression of GO may help define metabolic and weight-loss management for Graves’ disease and other autoimmune disorders. While we hypothesize that a reduction in systemic inflammation, rather than direct orbital fat loss, contributed to our patient’s improvement in her thyroid orbitopathy, this case presents an intriguing possibility that warrants further investigation. Presentation: Monday, July 14, 2025