Introduction: Graves orbitopathy (GO) is an autoimmune disease affecting the orbits and the periorbital tissues with an annual incidence of 16 per 100,000 population in women and 2.9 in men. While GO occurs in the spectrum of hyperthyroidism or Graves disease, 7.9% of these patients have a normal thyroid function and only a few are negative for thyroid antibodies. When left untreated, GO may become debilitating and threaten vision. Case Description: A 64-year-old male presented with gross bilateral proptosis and chemosis, which developed over a period of 10 years. Palpitations, hand tremors, heat intolerance, weight loss, and insomnia were notably absent, and the thyroid gland was normal. The bilateral proptosis was left unattended for 10 years until extreme lagophthalmos and chemosis with corneal and mucosal exposure leading to dryness, foreign body sensation, excruciating eye pain, and blurred vision resulted. Thyroid-stimulating hormone (TSH), T3, and T4, were normal. TSH-receptor antibody (TRAb) and thyroid peroxidase antibody were negative. The computed tomography scan with contrast of the orbits showed bilateral proptosis and extraocular muscle enlargement typical for thyroid eye disease. The patient was diagnosed with TRAb- negative euthyroid GO with a European Group on Graves’ Orbitopathy (EUGOGO) clinical score of 7/7, indicating a severe, active disease. Screening prior to administration of GO immunosuppressive therapy revealed chronic hepatitis B infection. The patient was started with tenofovir for 2 weeks before treatment for GO. The patient was given intravenous methylprednisolone with cumulative dose of 4.5 g for 12 weeks, with daily mycophenolate sodium 0.72 g for 12 weeks. Upon completing the 12-week treatment regimen and undergoing an adjunctive lateral canthotomy and partial tarsorrhaphy, the GO signs and symptoms dramatically resolved, and visual acuity markedly improved. Conclusion This case report presents an unusual condition of a euthyroid, TRAb-negative Graves orbitopathy. It provides insights on the diagnosis and treatment of patients with such atypical presentation. Despite the chronicity and severity of this patient’s GO, excellent results were achieved with appropriate and guideline-directed treatment.
Human ; Male ; Middle Aged: 45-64 Yrs Old ; Graves Ophthalmopathy ; Exophthalmos ; Mycophenolic Acid

Objective: To determine the effect of laparoscopic adjustable gastric banding (LAGB) on weight loss and the association between initial body mass index (BMI) and successful weight loss, defined as >50% excess weight loss (EWL) among obese Filipino adults at St. Luke’s Medical Center. Methodology: Data from 97 patients who were at least 18 years old at the time of gastric banding were reviewed retrospectively. Patient follow-up was poor 2 years post-surgery, which precluded analysis of follow-up data beyond 2 years. Changes in weight loss parameters from baseline to the different observation periods were carried out using paired t- test. To determine the association of different factors with success in weight loss, Independent t-test and Chi-square tests were used. A p-value ≤0.05 was considered significant. Results: Majority of the patients were female (61%) and Southeast Asian (77%). Ages ranged from 18 to 68 years. Mean BMI was 44.1 ± 0.1 kg/m2 and mean excess weight was 61.4 ± 26.5 kg. Excess weight loss of 43.84 ± 25.09% and BMI reduction of 21.54 ± 13.39% were attained at 2 years. Lower initial BMI with a mean of 38.12±3.28 kg/m2 was associated with successful weight loss, 1 year after gastric banding (p<0.001). Conclusion Patients attained 43.84% EWL 2 years after gastric banding. Those with higher initial BMI were less likely to achieve successful weight loss 1 year after gastric banding.
Bariatric Surgery ; Obesity ; Weight Loss

Advances in the medical management of secondary hyperparathyroidism due to renal failure have decreased the use of parathyroidectomy as a treatment option. However, some patients with end-stage renal disease still progress to refractory hyperparathyroidism and debilitating bone disease, for which parathyroidectomy may be warranted. We describe a case of a 35-year-old female on chronic hemodialysis who presented with bone pains, deformities, decrease in height and recurrent pathologic fractures. She had markedly elevated parathyroid hormone (PTH), vitamin D deficiency, persistent hyperphosphatemia and hypocalcemia despite therapeutic measures. Subtotal parathyroidectomy was done with eventual improvement of biochemical abnormalities, resolution of bone pains and healing of fractures.

Human ; Female ; Adult ; Bone Diseases ; Fractures, Spontaneous ; Hyperparathyroidism, Secondary ; Hyperphosphatemia ; Hypocalcemia ; Kidney Failure, Chronic ; Parathyroid Hormone ; Parathyroidectomy ; Renal Dialysis ; Renal Insufficiency ; Vitamin D Deficiency