Thyroid eye disease with dysthyroid optic neuropathy 15 years after incomplete thyroidectomy
Year: 2026
Type: article
Study design: Case Report
Abstract: Thyroid eye disease (TED) is the most common extrathyroidal manifestation of Graves’ disease, while dysthyroid optic neuropathy (DON) is a rare, sight-threatening complication. We report the case of a woman in her late 70s who developed active TED with DON 15 years after an intended total thyroidectomy that was subsequently shown to be incomplete. She presented with progressive proptosis, diplopia and visual impairment, accompanied by markedly elevated thyrotropin-receptor antibodies, suppressed thyroid-stimulating hormone, and imaging-confirmed residual and ectopic thyroid tissue. Intravenous glucocorticoids were considered unsuitable because of age, previous ischaemic stroke and atrial fibrillation. Tocilizumab, an interleukin-6 receptor antagonist, was initiated; however, visual function deteriorated, requiring bilateral medial orbital decompression. Visual acuity improved, although diplopia persisted. Completion thyroidectomy was subsequently performed. This case demonstrates that incomplete thyroidectomy does not preclude late-onset, sight-threatening TED and that persistent antibody elevation, declining levothyroxine requirements and thyroid remnants may indicate ongoing autoimmune stimulation.
Source: BMJ Case Reports
Institutions: Herlev Hospital, Rigshospitalet
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7223297906