Queen Anne’s Sign in Biochemically Confirmed Graves’ Disease: A Clinical Paradox in an Adolescent

A bstract Queen Anne’s sign, defined as loss of the lateral third of the eyebrows, is classically associated with hypothyroidism. Its occurrence in hyperthyroidism is rare and may create diagnostic confusion, particularly in adolescents, where autoimmune thyroid disease may present atypically. A 15-year-old schoolgirl presented with a 1-year history of weight loss, palpitations, tremor, insomnia, irritability, and diffuse hair loss, along with secondary amenorrhea for 4 months. Examination revealed tachycardia (124 bpm), fine tremor, diffuse firm goiter, low body weight (36 kg), and striking Queen Anne’s sign. Despite this hypothyroid-associated sign, biochemical evaluation showed markedly elevated FT3 and FT4 and suppressed thyroid-stimulating hormone (TSH) levels. Autoimmune testing revealed strongly positive TSH-receptor and antithyroid peroxidase antibodies. Thyroid scintigraphy demonstrated diffusely increased radiotracer uptake, consistent with Graves’ disease. Treatment with carbimazole (45–60 mg/day) resulted in rapid clinical improvement, weight gain to 50 kg, and restoration of scalp hair and eyebrows. Queen Anne’s sign is not pathognomonic for hypothyroidism and may rarely present in severe thyrotoxicosis. Awareness of this paradox prevents misdiagnosis and highlights the importance of biochemical confirmation in thyroid disorders.