A 9-year-old girl presents to the emergency department for left eye proptosis and headaches. The symptoms started approximately 2 months earlier, and initially the parents decided to watch when the symptoms first developed as there was a strong family history of hyperthyroidism and proptosis. When the symptoms persisted for a month, she was brought to an optometrist, who noted conjunctival injection on examination, and was given antihistamine ophthalmic drops for a concern of allergies. The symptoms did not improve, however, and she saw her pediatrician and was subsequently sent to the emergency department for evaluation.

Initial complete blood cell count, basic metabolic panel, liver function tests, and thyroid function tests are normal. A computed tomographic (CT) scan of the head is performed and demonstrates a 4.0 × 5.5 × 4.0-cm retro-orbital enhancing mass. The patient is then transferred to a tertiary academic medical center for further evaluation and care. On...

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