Thyroid eye disease with dysthyroid optic neuropathy 15 years after incomplete thyroidectomy
- 1Department of Internal Medicine, Herlev Hospital, Herlev, Denmark
- 2Department of Ophtalmology, Rigshospitalet, Copenhagen, Capital Region of Denmark, Denmark
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.
Related
- The utility of computed tomography and magnetic resonance imaging in the diagnosis and surgical planning of thyroid eye disease and dysthyroid optic neuropathy
- Characteristics and Management of a Cohort of Patients with Asymmetric Thyroid Eye Disease and Unilateral Dysthyroid Optic Neuropathy Undergoing Unilateral Orbital Decompression Surgery
- Heterogeneous TRAb trajectories after total thyroidectomy in graves’ disease with thyroid eye disease
- Teprotumumab-associated persistent unilateral hearing loss in dysthyroid optic neuropathy: a case report with review of the literature
- Teprotumumab for dysthyroid optic neuropathy: early functional and structural improvement in a retrospective case series
BibTeX
@article{bytyqi2026thyroid,
title = {{Thyroid eye disease with dysthyroid optic neuropathy 15 years after incomplete thyroidectomy}},
author = {Floriana Bytyqi and Jens Pedersen and Jesper Skovlund Jørgensen and Peter Bjerre Toft and Birte Nygaard},
journal = {BMJ Case Reports},
year = {2026},
month = oct,
doi = {10.1136/bcr-2026-275833},
url = {https://doi.org/10.1136/bcr-2026-275833},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Thyroid eye disease with dysthyroid optic neuropathy 15 years after incomplete thyroidectomy
AU - Floriana Bytyqi
AU - Jens Pedersen
AU - Jesper Skovlund Jørgensen
AU - Peter Bjerre Toft
AU - Birte Nygaard
PY - 2026
DA - 2026/10/23
JO - BMJ Case Reports
DO - 10.1136/bcr-2026-275833
UR - https://doi.org/10.1136/bcr-2026-275833
AB - 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.
SN - 1757-790X
ER -