An Interesting Case of Euthyroid Graves’ Ophthalmopathy, With Negative Thyroid-Stimulating Hormone Receptor Antibodies

Thyroid eye disease (TED), also known as Graves' orbitopathy or ophthalmopathy (GO) or Graves' eye disease, is an autoimmune condition of the retroocular tissues associated with Graves’ disease. In isolated GO, the patient can present without thyroid hormone dysfunction or systemic symptom...

Full description

Saved in:
Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2021-10, Vol.13 (10)
Main Authors: Moeen, Zunera, Aliuddin, Ammar M, Gray Wlazlo, Taylor, Majid, Hira, Kolli, Swapna
Format: Article
Language:English
Subjects:
Antibodies
Case reports
Classification
Diabetes
Diplopia
Edema
Endocrinology
Endocrinology/Diabetes/Metabolism
Fibroblasts
Hyperthyroidism
Immunotherapy
Inflammation
Internal Medicine
Magnetic resonance imaging
Monoclonal antibodies
Ophthalmology
Pain
Pathophysiology
Patients
Steroids
Thyroid gland
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Thyroid eye disease (TED), also known as Graves' orbitopathy or ophthalmopathy (GO) or Graves' eye disease, is an autoimmune condition of the retroocular tissues associated with Graves’ disease. In isolated GO, the patient can present without thyroid hormone dysfunction or systemic symptoms of Graves’ disease, in which case it is called euthyroid Graves’ ophthalmopathy (EGO). It is very rare for this condition to have negative thyroid-stimulating hormone receptor (TSHR) autoantibodies, and we present such a rare case of a young female, who had progressive bilateral vision loss, intermittent left-sided retroocular headache, and severe bilateral proptosis. The patient was diagnosed with EGO based on multidisciplinary consults, diagnostic orbital magnetic resonance imaging (MRI) results, and a good response to treatment with intravenous steroids. Later, the patient was followed as an outpatient and treated with thyroid orbitopathy-specific immunotherapy with teprotumumab. The patient’s response to teprotumumab was excellent and caused significant improvement in visual acuity, proptosis, and chemosis. This adds valuable literature to the medical field and gives insight to clinicians to consider the diagnosis of GO even with seronegative TSHR autoantibodies and euthyroid hormone status. It also adds to the understanding of the complex pathophysiology of this rare condition.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.19015