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Thyroid antibody-negative euthyroid Graves' ophthalmopathy

Tabasum, Arshiya, Khan, Ishrat, Taylor, Peter, Das, Gautam and Okosieme, Onyebuchi 2016. Thyroid antibody-negative euthyroid Graves' ophthalmopathy. Endocrinology, Diabetes & Metabolism Case Reports 2016 (1) , EDM160008. 10.1530/EDM-16-0008

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Abstract

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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: BioScientifica
ISSN: 2052-0573
Date of Acceptance: 16 May 2016
Last Modified: 19 Jun 2019 10:10
URI: http://orca-mwe.cf.ac.uk/id/eprint/101946

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