PMID- 33246456
OWN - NLM
STAT- MEDLINE
DCOM- 20210823
LR  - 20210823
IS  - 1472-6823 (Electronic)
IS  - 1472-6823 (Linking)
VI  - 20
IP  - 1
DP  - 2020 Nov 27
TI  - A case report of thyroid-associated Orbitopathy with elevated TPO antibodies.
PG  - 176
LID - 10.1186/s12902-020-00658-6 [doi]
LID - 176
AB  - BACKGROUND: Thyroid associated orbitopathy (TAO) is defined as an immune mediated 
      inflammatory process affecting the extraocular muscles, connective and adipose 
      tissue of uncertain etiopathogenesis. TAO are classically described in Grave's 
      disease (GD) however it may occur in euthyroid and hypothyroid patients. Those 
      patients usually test positive for Thyroid Stimulating Hormone receptor 
      antibodies (TRAb). For instance, only few cases of severe Hashimoto's thyroiditis 
      (HT) associated orbitopathy with negative TRAb are reported to date. CASE 
      PRESENTATION: Herewith we report a rare case of a middle-aged female who 
      presented with bilateral progressive upper and lower palpebral edema and a 
      unilateral marked proptosis associated with asthenia, headache and decrease in 
      visual acuity. Biological investigation was notable for high levels of 
      anti-thyroid peroxidase antibodies (Anti-TPO) in an otherwise euthyroid patient 
      with negative TRAb. Orbital Magnetic resonance imaging revealed edema of the 
      extraocular muscles and inflammation of periorbital soft tissue. The patient 
      received a treatment with intravenous methylprednisolone followed by oral 
      treatment with prednisone. This regimen was both effective and safe with minimal 
      metabolic side effects in our patient. CONCLUSION: Minor ocular manifestations of 
      HT are common; however, severe sight threatening ophtalmopathy in the absence of 
      TRAb is rare. Multiple differential diagnosis should be considered and 
      investigated before diagnosing this rare entity. Management of similar cases is 
      currently based on reports and no clear guidelines have been elaborated, 
      corticosteroids is the mainstream of treatment with a potential benefit of 
      selenium supplementation in mild to moderate cases.
FAU - El Othman, Radwan
AU  - El Othman R
AD  - Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik 
      (USEK), Jounieh, Lebanon. radwan_el_othman@hotmail.com.
FAU - Ephrem, Christelle
AU  - Ephrem C
AD  - Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik 
      (USEK), Jounieh, Lebanon.
AD  - Department of Internal Medicine, University Hospital Center- Notre Dame des 
      Secours, Byblos, Lebanon.
FAU - Touma, Elsie
AU  - Touma E
AD  - Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik 
      (USEK), Jounieh, Lebanon.
FAU - Hallit, Souheil
AU  - Hallit S
AUID- ORCID: 0000-0001-6918-5689
AD  - Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik 
      (USEK), Jounieh, Lebanon. souheilhallit@hotmail.com.
AD  - INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et 
      Toxicologie-Liban, Beirut, Lebanon. souheilhallit@hotmail.com.
FAU - El Othman, Rola
AU  - El Othman R
AD  - Bahman Hospital, Beirut, Lebanon.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20201127
PL  - England
TA  - BMC Endocr Disord
JT  - BMC endocrine disorders
JID - 101088676
RN  - 0 (Autoantibodies)
RN  - EC 1.11.1.8 (Iodide Peroxidase)
SB  - IM
MH  - Autoantibodies/*blood/immunology
MH  - Female
MH  - Graves Ophthalmopathy/blood/immunology/*pathology
MH  - Humans
MH  - Iodide Peroxidase/*immunology
MH  - Middle Aged
MH  - Prognosis
PMC - PMC7693503
OTO - NOTNLM
OT  - Case report
OT  - Hashimoto's disease
OT  - Hashimoto's thyroiditis
OT  - Ophtalmopathy
OT  - Orbitopathy
COIS- There authors have no conflict of interest to disclose.
EDAT- 2020/11/29 06:00
MHDA- 2021/08/24 06:00
PMCR- 2020/11/27
CRDT- 2020/11/28 05:23
PHST- 2020/02/10 00:00 [received]
PHST- 2020/11/22 00:00 [accepted]
PHST- 2020/11/28 05:23 [entrez]
PHST- 2020/11/29 06:00 [pubmed]
PHST- 2021/08/24 06:00 [medline]
PHST- 2020/11/27 00:00 [pmc-release]
AID - 10.1186/s12902-020-00658-6 [pii]
AID - 658 [pii]
AID - 10.1186/s12902-020-00658-6 [doi]
PST - epublish
SO  - BMC Endocr Disord. 2020 Nov 27;20(1):176. doi: 10.1186/s12902-020-00658-6.