Clinical features of thyroid-associated ophthalmopathy in clinically euthyroid Korean patients

Abstract

Aim To compare clinical characteristics and thyroid-stimulating hormone receptor antibodies (TRAbs) in thyroid-associated ophthalmopathy (TAO) in euthyroid Korean patients with those in hyperthyroid patients. Methods Clinical activity scores (CASs), modified NOSPECS scores, exophthalmometry values, prevalence of optic neuropathy, restrictive myopathy and lid retraction, and the positivity and levels of TRAb (thyrotropin-binding inhibitor immunoglobulin (TBII) and thyroidstimulating immunoglobulin (TSI)) were compared in 24 euthyroid (group A) and 139 clinical/subclinical hyperthyroid TAO patients (group B). Results Group A presented more clinically unilateral involvement than group B (79.2% vs 27.3%, Po0.001), less active (CAS 1.50 vs 2.26, P ¼ 0.014) and less severe clinical course (NOSPECS 3.38 vs 4.13, P ¼ 0.037). Lid retraction was more prevalent in group A than group B (91.7% vs 66.2%, P ¼ 0.014). Prevalence of optic neuropathy and restrictive myopathy, and the mean value of exophthalmometry were not different. Mean TBII levels were lower (7.20 IU/l) in group A than in group B (44.58 IU/l, Po0.001). A similar difference was found in the TSI bioassay (201.40% vs 425.19%, P ¼ 0.001). The positive rate of TBII in group A (34.8%) was significantly lower than in group B (90.8%, Po0.001). The positive rate of TSI was high in both group A (83.3%) and B (91.7%), with no significant difference (P ¼ 0.337).Conclusions Patients with euthyroid TAO showed a less active and severe clinical course, more unilateral involvement, and lower levels of TRAb than those in patients with hyperthyroid TAO. These distinct clinical and biochemical characteristics might be useful in assessment of euthyroid TAO, and the TSI might be more sensitive for diagnosing these patients.

Prevalence, Phenotype, and Psychosocial Well-Being in Euthyroid/Hypothyroid Thyroid-Associated Orbitopathy

“…Further, it has been shown that euor hypothyroid TAO can be associated with ocular myasthenia gravis (15), with an ectopic thyroid gland (16), or with papillary thyroid microcarcinoma (17,18). Single studies have suggested that euthyroid and primarily hypothyroid patients develop milder and significantly more asymmetrical TAO (6,19). Severe TAO is rare in these cases but a few case reports have described primarily euthyroid or hypothyroid TAO patients with clinically severe TAO requiring systemic immunosuppression (20).…”

Development of Thyroid-Associated Ophthalmopathy in Patients Who Underwent Total Thyroidectomy

“…Case reports of euthyroid TAO several decades ago also describe patients with ocular signs of TAO and normal thyroid function without previous history of hyperthyroidism. 16 17 To our knowledge, our study is the first to report euthyroid TAO following total thyroidectomy. In the present study, case 6 demonstrated severe active TAO despite undergoing total thyroidectomy for a benign thyroid mass 10 years prior to the ophthalmology department visit.…”

A Case of Unilateral Exophthalmos Due To Thyroid Orbitopathy in A Clinically Euthyroid Patient

“…However, euthyroid patients are more likely to have unilateral eye involvement as compared to hyperthyroid individuals. Jang et al reported increased incidence of unilateral eye involvement (79.2%) in euthyroid patients as compared to patients with hyperthyroidism (27.3%) (8). Eckstein et al also reported increased incidence of asymmetric eye involvement in euthyroid patients as compared to hyperthyroid patients (9).…”