Anti-Eye Muscle Antibodies and Hypothyroid Graves' Disease: A Case Report.

Abstract

Abstract. We report the case of a 70-year-old man who developed hypothyroidism associated with TSH receptor antibodies and severe ophthalmopathy during lithium therapy. He had received lithium therapy for more than 20 years for manic depression, when ophthalmopathy (class VI of the American Thyroid Association classification) and mild hypothyroidism developed. Orbital magnetic resonance imaging indicated marked enlargement of the superior, medial and inferior rectus muscles in the left eye. He had anti-eye muscle antibodies in his serum, detected by Western blotting and quantified by chromatoscanning, as well as anti-TSH receptor antibodies. He was treated with supplementation of levothyroxine and four cycles of methylprednisolone pulse therapy. After the pulse therapy, both anti-eye muscle antibodies and anti-TSH receptor antibodies decreased and disappeared in parallel with the improvement in eye symptoms and signs. These observations suggest the importance of anti-eye muscle antibodies as clinical markers in the development of thyroid-associated ophthalmopathy.

Rituximab therapy in steroid-resistant severe hypothyroid Grave′s ophthalmopathy

“…[11] reported high prevalence of eye signs (34%) in patients with Hashimoto's thyroiditis. Involvement of eye has also been reported in subjects with hypothyroidism on various drugs, namely thiazolidinedione,[12] lithium,[13] ipilimumab alone or combined with bevacizumab therapy. [14] Most patients of hypothyroid and euthyroid Grave's ophthalmopathy present as asymmetrical ophthalmopathy with little soft tissue involvement with low titers of TSHR antibodies and anti-TPO antibodies.…”

“…One of the earliest reports of treatment of HypoGO was by Hiromatsu, et al . [13] in which they reported improvement of eye signs after pulse methylprednisolone therapy and decrease in anti-TSH receptor antibodies. Grzesiuk, et al .…”