Clinical course of thyroid function and thyroid associated-ophthalmopathy in patients with euthyroid Graves’ disease

Abstract

BackgroundEuthyroid Graves’ disease (EGD) is a rare condition defined as the presence of thyroid-associated ophthalmopathy (TAO) in patients with normal thyroid function. Due to the rarity of this disease, only a limited number of studies and case reports are available for further evaluation of the characteristics of the disease. The aim of this study was to examine the changes in the thyroid function, thyrotropin receptor antibodies (TRAb) and eye symptoms, and then determine whether TRAb is related to TAO in EGD patients. TRAb in this study was defined as including both thyrotropin-binding inhibitory immunoglobulin (TBII) and thyroid-stimulating immunoglobulin (TSAb).Patients and methodsMedical records of patients diagnosed with EGD were reviewed. Ophthalmologists specializing in TAO examined the eyes of all subjects.ResultsOf the 58 patients diagnosed with EGD, 24.1% developed hyperthyroidism, while 3.4% developed hypothyroidism. A total of 72.4% of the 58 patients remained euthyroid throughout the entire follow-up period. At the initial presentation, TBII and TSAb were positive in 74.5% and 70.5%, respectively. Ophthalmic treatments were administered to 30 (51.7%) out of the 58 patients. A significant spontaneous improvement of the eye symptoms was found in 28 of the EGD patients who did not require eye treatments. EGD patients exhibited positive rates for both TBII and TSAb, with the number of the TRAb-positive patients gradually decreasing while the eye symptoms spontaneously improved over time. There were no correlations found between TRAb at initial presentation and the eye symptoms.ConclusionTBII and TSAb were positive in about 70% of EGD patients at their initial visit. Thyroid functions of EGD patients who have been euthyroid for more than 6.7 years may continue to remain euthyroid in the future.

Type 2 Autoimmune Polyglandular Syndrome Presenting with Hyperpigmentation and Amenorrhea

“…A CT scan may sometimes be indicated to better visualize the retro ocular tissues and determine appropriate management. The ophthalmopathy follows its own independent clinical course, irrespective of the thyroid status [10]. Smoking and use of radioiodine therapy can exacerbate the eye disease [11].…”

Spontaneous resolution of euthyroid optic neuropathy

“…The case patient showed elevated TRAb levels, which also supported our diagnosis. TRAb is elevated in 70% of euthyroid Graves' orbitopathy patients, 14 although the level of this antibody does not correspond to the severity of the orbitopathy. 14 Follow-up of thyroid hormone levels is mandatory in these cases, as 24% to 50% of euthyroid Graves' orbitopathy patients will develop hyperthyroidism within several years.…”

“…14 Follow-up of thyroid hormone levels is mandatory in these cases, as 24% to 50% of euthyroid Graves' orbitopathy patients will develop hyperthyroidism within several years. 14 The case patient was taking loxoprofen sodium, a nonselective cyclooxygenase (COX) inhibitor, before the first presentation. COX inhibitors are potential therapeutic agents for Graves' orbitopathy, as COX-2 contributes to the pathogenesis of adipogenesis.…”

Voxel-Based Morphometric Features of Dysthyroid Optic Neuropathy

“…YHT, XZL, JLG eviewed and edited the manuscript. All authors read and approved the manuscript Acknowledgments: the authors thank Dr.Xiaozhou Hu and Dr.Jieliang Shi [1]for collecting the clinical data.…”

“…Thyroid associated ophthalmology (TAO) is an autoimmune disease, always comorbid with dysfunction of thyroid [1,2] . The physical manifestation of TAO includes proptosis, upper and lower eyelid retraction, periorbital edema, diplopia, photophobia.…”