Lid retraction or lid lag on physical examination is most consistent with which thyroid condition?

• A. Hypothyroidism
• B. Diabetes mellitus
• C. Hyperthyroidism
• D. Cushing's syndrome

Answer: (C)

Lid retraction and lid lag reflect thyrotoxic state. In hyperthyroidism, excess thyroid hormone boosts sympathetic activity and increases the tone of the muscles lifting the upper eyelid (Müller muscle and levator). This pulls the lid higher, so the eye appears more open even at rest. When the gaze moves downward, the lid doesn’t track the globe promptly, producing lid lag. This combination is most classically seen with hyperthyroidism, especially Graves’ disease.

Other options don’t typically produce this sign: hypothyroidism more often yields facial puffiness and slowed reflexes rather than an overly elevated lid; diabetes mellitus isn’t associated with lid retraction or lid lag; Cushing’s syndrome doesn’t present with this ocular finding.