A systematic review of euthyroid Graves' disease (Review)

Abstract

Euthyroid Graves' Disease (EGD) is a challenging pathology, due to its atypical clinical manifestations and the absence of abnormal thyroid function. Typically, thyroid ophthalmopathy is associated with elevated thyroid hormone levels and with the presence of thyrotropin receptor antibodies (TRAb) but a low percentage of patients remain euthyroid without developing hyperthyroidism during long-term follow-up periods. Although it is considered a different pathology, it shares a lot of similarities with Graves' disease, rendering the diagnosis more difficult. It is also important to note that ophthalmopathy may be the first clinical manifestation of Graves' disease and that thyroid function examinations do not present abnormalities over a long period. Treatment choices for euthyroid disease do not differ from those described in Graves' ophthalmopathy. However, it is considered that since euthyroid patients develop milder ophthalmic symptoms and their clinical activity score is lower, they tend to have better responses to treatment. Moreover, atypical sight-threatening cases such as exposure keratopathy and dysthyroid optic neuropathy with variable responses to therapy also exist. Disease management consists of a favorable collaboration between ophthalmologists and endocrinologists because patients with EGD can develop thyroid abnormalities over time. In conclusion, the diagnosis of EGD is difficult, clinical manifestations and evolution are variables depending on several factors, including the heterogeneity of TRAb. This review aimed to identify the characteristics of this disease by reviewing the clinical studies and case reports published in previous years.

Correlation between extraocular muscle enlargement and thyroid autoantibodies in thyroid eye disease

“…TED with normal thyroid hormone levels (euthyroid Graves disease) is a rare entity. However, its incidence has been reported [ 34 ]. Thus, measuring the autoantibody levels, to ensure that the diagnosis of TED is not overlooked, is important.…”

Ocular surface and meibomian gland evaluation in euthyroid Graves’ ophthalmopathy

“…EGO is more prevalent in males, associated with lower disease activity, and more asymmetrical. 5 The activation of thyroid-stimulating hormone receptors induces the pathogenesis of both Graves’ disease and TED. EGO presents with a normal thyroid function, and the targets are tissue cells in the eye and the orbit.…”

Macular microvasculature in patients with thyroid-associated orbitopathy: a cross-sectional study

“…Thyroid-associated orbitopathy (TAO) is an inflammatory disorder involving intraorbital tissues. Due to inflammation and stimulation of adipogenesis, an increase in the volume of intraorbital fat and extraocular muscles occurs, which leads to compressive effects on the optic nerve as well as impaired venous drainage [ 5 ]. Mechanisms such as compartment syndrome and congestive optic neuropathy due to venous insufficiency can cause neuronal damage [ 6 ].…”