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Tabasum A, Khan I, Taylor P, et al. Thyroid antibody-negative euthyroid Graves' ophthalmopathy. Endocrinol Diabetes Metab Case Rep. 2016;2016:160008doi: 10.1530/EDM-16-0008.
Tabasum, A., Khan, I., Taylor, P., Das, G., & Okosieme, O. E. (2016). Thyroid antibody-negative euthyroid Graves' ophthalmopathy. Endocrinology, diabetes & metabolism case reports, 2016160008. https://doi.org/10.1530/EDM-16-0008
Tabasum, Arshiya, et al. "Thyroid antibody-negative euthyroid Graves' ophthalmopathy." Endocrinology, diabetes & metabolism case reports vol. 2016 (2016): 160008. doi: https://doi.org/10.1530/EDM-16-0008
Tabasum A, Khan I, Taylor P, Das G, Okosieme OE. Thyroid antibody-negative euthyroid Graves' ophthalmopathy. Endocrinol Diabetes Metab Case Rep. 2016;2016:160008. doi: 10.1530/EDM-16-0008. Epub 2016 Jun 02. PMID: 27284451; PMCID: PMC4898069.
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Endocrinol Diabetes Metab Case Rep. 2016;2016:160008. doi: 10.1530/EDM-16-0008. Epub 2016 Jun 02.

Thyroid antibody-negative euthyroid Graves' ophthalmopathy.

Endocrinology, diabetes & metabolism case reports

Arshiya Tabasum, Ishrat Khan, Peter Taylor, Gautam Das, Onyebuchi E Okosieme

Affiliations

  1. Department of Diabetes and Endocrinology , Prince Charles Hospital, Cwm Taf Health Board, Merthyr Tydfil , UK.
  2. Department of Diabetes and Endocrinology, Prince Charles Hospital, Cwm Taf Health Board, Merthyr Tydfil, UK; Thyroid Research Group, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff, UK.

PMID: 27284451 PMCID: PMC4898069 DOI: 10.1530/EDM-16-0008

Abstract

UNLABELLED: TSH receptor antibodies (TRAbs) are the pathological hallmark of Graves' disease, present in nearly all patients with the disease. Euthyroid Graves' ophthalmopathy (EGO) is a well-recognized clinical entity, but its occurrence in patients with negative TRAbs is a potential source of diagnostic confusion. A 66-year-old female presented to our endocrinology clinic with right eye pain and diplopia in the absence of thyroid dysfunction. TRAbs were negative, as measured with a highly sensitive third(-)generation thyrotropin-binding inhibitory immunoglobulin (TBII) ELISA assay. CT and MRI scans of the orbit showed asymmetrical thickening of the inferior rectus muscles but no other inflammatory or malignant orbital pathology. Graves' ophthalmopathy (GO) was diagnosed on the basis of the clinical and radiological features, and she underwent surgical recession of the inferior rectus muscle with complete resolution of the diplopia and orbital pain. She remained euthyroid over the course of follow-up but ultimately developed overt clinical and biochemical hyperthyroidism, 24 months after the initial presentation. By this time, she had developed positive TRAb as well as thyroid peroxidase antibodies. She responded to treatment with thionamides and remains euthyroid. This case highlights the potential for negative thyroid-specific autoantibodies in the presentation of EGO and underscores the variable temporal relationship between the clinical expression of thyroid dysfunction and orbital disease in the natural evolution of Graves' disease.

LEARNING POINTS: Euthyroid Graves' ophthalmopathy can present initially with negative thyroid-specific autoantibodies.Patients with suggestive symptoms of ophthalmopathy should be carefully evaluated for GO with imaging studies even when thyroid function and autoantibodies are normal.Patients with EGO can develop thyroid dysfunction within 4 years of follow-up underpinning the need for long-term follow-up and continued patient and physician vigilance in patients who have been treated for EGO.

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