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Graves' ophthalmopathy and atrophic thyroiditis: a case report
G Tamagno1, E De Carlo, C Betterle
1Department of Medical and Surgical Sciences, University of Padua, Padua, Italy.
Journal of Endocrinological Investigation
|May 8, 2004
Summary
Graves' ophthalmopathy (GO) rarely occurs in patients with autoimmune thyroiditis. This case highlights a severe, late-onset GO in an 88-year-old woman with primary myxedema and TSH receptor antibodies.
Area of Science:
- Endocrinology
- Ophthalmology
- Immunology
Background:
- Graves' ophthalmopathy (GO), or thyroid-associated orbitopathy, typically affects patients with Graves' disease.
- It is an extra-thyroidal manifestation linked to TSH receptor antibodies.
- GO is less common in euthyroid individuals and rare in Hashimoto's thyroiditis.
Observation:
- A severe, late-onset case of GO occurred in an 88-year-old woman with primary myxedema due to atrophic thyroiditis.
- The patient presented with severe GO despite the absence of hyperthyroidism.
- This presentation is considered exceptional.
Findings:
- The patient exhibited elevated serum auto-antibodies against the TSH receptor.
- Levels of anti-thyroglobulin and thyroperoxidase antibodies were normal or only slightly elevated.
- This suggests a specific autoimmune profile associated with the observed GO.
Implications:
- This case expands the understanding of GO presentation beyond typical Graves' disease.
- It underscores the potential for severe GO in patients with underlying autoimmune thyroiditis, even with primary myxedema.
- The findings emphasize the role of TSH receptor antibodies in GO pathogenesis, irrespective of overt thyroid dysfunction.