Immune Reconstitution Graves Ophthalmopathy Induced by Haart Therapy in a Hypothyroid Male Patient

The objective is to report a rare case of a 41-year-old African American male who recently developed Graves Ophthalmopathy (GO) secondary to highly active antiretroviral therapy (HAART) induced Immune reconstitution inflammatory syndrome (IRIS). He is a known case of primary hypothyroidism treated with Levothyroxine since the age of 33 and found with AIDS at the age of 34 when HAART therapy was started. He then developed Graves disease (GD) with worsening GO when his CD4 T-cell counts improved. We treated our patient with Methimazole and followed him at regular intervals until his thyroid levels normalized. GD is an autoimmune condition caused by Thyroid stimulating immunoglobulins (TSI) leading to hyperthyroidism. Ocular problems are one of its manifestations, ranging from simple irritation to proptosis and even complete loss of vision. Patients on HAART may develop IRIS in 10-25 % of cases. Less than 1 % of IRIS cases present as GD and out of them only 25 % have reported GO which were of a milder version. Our case is the first case to show two coinciding points, one is development of a severe degree of GO and the other is the transition from hypothyroidism to Graves disease in a male patient treated with HAART.