ECE2022 Eposter Presentations Thyroid (219 abstracts)
A case of graves’ orbitopathy in a patient sero-negative for TSH receptor autoantibody
Chayma Besrour , Rojbi Imen , Mekni Sabrine , Meriem Adel , Mchirgui Nadia , Ben Nacef Ibtissem & Khiari Karima
Hospital Charles Nicolle, Endocrinology, Tunis, Tunisia
Introduction: The orbit represents the second target after the thyroid gland in autoimmune dysthyroidism. In 80% of cases, endocrine orbitopathy occurs as a result of hyperthyroidism, especially Grave’s disease (GD). Males are rarely affected but the damage is more serious.
Observation: We report the case of a 52-year-old patient, an active smoker (35 Pack-Year), transferred from the neurology department for treatment of bilateral malignant exophthalmos with subclinical hyperthyroidism. The examination showed a palpable normal sized thyroid with no vascularity. Orbital MRI showed bilateral grade 2 proptosis with oculomotor muscle hypertrophy consistent with Grave’s orbitopathy (GO). The biology showed a subclinical hyperthyroidism, but the assay of the anti-TSH receptor antibodies came back negative twice. A thyroid scintigraphy was performed and it confirmed the Grave’s disease. The patient was treated with corticosteroid therapy for his GO and showed a slight improvement. As for his subclinical hyperthyroidism, he was put on a low dose of an anti-thyroid drug, and developed euthyroidism.
Discussion: GO concerns 50% of patients with GD, among them only 3-5% develop severe forms. The responsible pathophysiological mechanism is linked to the presence of TRAKs. But these antibodies are only present in 95% of cases; suggesting are there other mechanisms to this GO?
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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