Transition from hypothyroidism to Graves’ disease, development of thyroid eye disease, progression to optic neuropathy after inpatient pulse therapy, and long-term administration of outpatient pulse therapy: a case report with review of literature
A 55-year-old woman transitioned from hypothyroidism to Graves’ disease (GD) and then developed thyroid eye disease (TED) with proptosis and diplopia. After three cycles of daily methylprednisolone pulse therapy, her condition progressed to dysthyroid optic neuropathy with decreased visual acuity in...
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| Format: | Article |
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The Japan Endocrine Society
2025-01-01
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| Series: | Endocrine Journal |
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| Online Access: | https://www.jstage.jst.go.jp/article/endocrj/72/1/72_EJ24-0347/_html/-char/en |
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| author | Koichiro Mizuochi Yuji Hiromatsu Yui Nakamura Aya Sonezaki Ayaka Adachi Tamotsu Kato Nobuhiko Wada Tomohiro Kurose Shiho Watanabe |
| author_facet | Koichiro Mizuochi Yuji Hiromatsu Yui Nakamura Aya Sonezaki Ayaka Adachi Tamotsu Kato Nobuhiko Wada Tomohiro Kurose Shiho Watanabe |
| author_sort | Koichiro Mizuochi |
| collection | DOAJ |
| description | A 55-year-old woman transitioned from hypothyroidism to Graves’ disease (GD) and then developed thyroid eye disease (TED) with proptosis and diplopia. After three cycles of daily methylprednisolone pulse therapy, her condition progressed to dysthyroid optic neuropathy with decreased visual acuity in both eyes. Her clinical activity score (CAS) was 7 points. Orbital magnetic resonance imaging (MRI) showed that the enlarged extraocular muscles were compressing the optic nerve in the area of the cones. Although her visual acuity recovered during two further cycles of daily pulse therapy, disease activity persisted for 4 years. TED exacerbated five times. Each time, the patient received weekly pulse therapy with no adverse reactions until her ophthalmopathy was relieved. The total cumulative dose of methylprednisolone was 59.5 g. Thyroid-stimulating antibody (TSAb) was positive from the time of hypothyroidism onset and became strongly positive with the onset of GD and the progress of TED. In addition, MRI was useful for the evaluation of the pathophysiology of ophthalmopathy. This case report suggests that careful monitoring by both endocrinologists and ophthalmologists using CAS, ophthalmological assessments, TSAb measurement, and orbital MRI are useful for making treatment decisions for TED. |
| format | Article |
| id | doaj-art-af4c82c17d574f878f7e5f7560fb013a |
| institution | Kabale University |
| issn | 1348-4540 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | The Japan Endocrine Society |
| record_format | Article |
| series | Endocrine Journal |
| spelling | doaj-art-af4c82c17d574f878f7e5f7560fb013a2025-01-22T05:36:48ZengThe Japan Endocrine SocietyEndocrine Journal1348-45402025-01-0172111512210.1507/endocrj.EJ24-0347endocrjTransition from hypothyroidism to Graves’ disease, development of thyroid eye disease, progression to optic neuropathy after inpatient pulse therapy, and long-term administration of outpatient pulse therapy: a case report with review of literatureKoichiro Mizuochi0Yuji Hiromatsu1Yui Nakamura2Aya Sonezaki3Ayaka Adachi4Tamotsu Kato5Nobuhiko Wada6Tomohiro Kurose7Shiho Watanabe8Diabetes Center, Kurume University Medical Center, Kurume 839-0863, JapanDiabetes Center, Kurume University Medical Center, Kurume 839-0863, JapanDiabetes Center, Kurume University Medical Center, Kurume 839-0863, JapanDiabetes Center, Kurume University Medical Center, Kurume 839-0863, JapanDiabetes Center, Kurume University Medical Center, Kurume 839-0863, JapanDiabetes Center, Kurume University Medical Center, Kurume 839-0863, JapanDiabetes Center, Kurume University Medical Center, Kurume 839-0863, JapanDepartment of Ophthalmology, Kurume University Medical Center, Kurume 839-0863, JapanDepartment of Ophthalmology, Kurume University Medical Center, Kurume 839-0863, JapanA 55-year-old woman transitioned from hypothyroidism to Graves’ disease (GD) and then developed thyroid eye disease (TED) with proptosis and diplopia. After three cycles of daily methylprednisolone pulse therapy, her condition progressed to dysthyroid optic neuropathy with decreased visual acuity in both eyes. Her clinical activity score (CAS) was 7 points. Orbital magnetic resonance imaging (MRI) showed that the enlarged extraocular muscles were compressing the optic nerve in the area of the cones. Although her visual acuity recovered during two further cycles of daily pulse therapy, disease activity persisted for 4 years. TED exacerbated five times. Each time, the patient received weekly pulse therapy with no adverse reactions until her ophthalmopathy was relieved. The total cumulative dose of methylprednisolone was 59.5 g. Thyroid-stimulating antibody (TSAb) was positive from the time of hypothyroidism onset and became strongly positive with the onset of GD and the progress of TED. In addition, MRI was useful for the evaluation of the pathophysiology of ophthalmopathy. This case report suggests that careful monitoring by both endocrinologists and ophthalmologists using CAS, ophthalmological assessments, TSAb measurement, and orbital MRI are useful for making treatment decisions for TED.https://www.jstage.jst.go.jp/article/endocrj/72/1/72_EJ24-0347/_html/-char/engraves’ diseasehashimoto’s thyroiditisdysthyroid optic neuropathypulse therapythyroid-stimulating antibody |
| spellingShingle | Koichiro Mizuochi Yuji Hiromatsu Yui Nakamura Aya Sonezaki Ayaka Adachi Tamotsu Kato Nobuhiko Wada Tomohiro Kurose Shiho Watanabe Transition from hypothyroidism to Graves’ disease, development of thyroid eye disease, progression to optic neuropathy after inpatient pulse therapy, and long-term administration of outpatient pulse therapy: a case report with review of literature Endocrine Journal graves’ disease hashimoto’s thyroiditis dysthyroid optic neuropathy pulse therapy thyroid-stimulating antibody |
| title | Transition from hypothyroidism to Graves’ disease, development of thyroid eye disease, progression to optic neuropathy after inpatient pulse therapy, and long-term administration of outpatient pulse therapy: a case report with review of literature |
| title_full | Transition from hypothyroidism to Graves’ disease, development of thyroid eye disease, progression to optic neuropathy after inpatient pulse therapy, and long-term administration of outpatient pulse therapy: a case report with review of literature |
| title_fullStr | Transition from hypothyroidism to Graves’ disease, development of thyroid eye disease, progression to optic neuropathy after inpatient pulse therapy, and long-term administration of outpatient pulse therapy: a case report with review of literature |
| title_full_unstemmed | Transition from hypothyroidism to Graves’ disease, development of thyroid eye disease, progression to optic neuropathy after inpatient pulse therapy, and long-term administration of outpatient pulse therapy: a case report with review of literature |
| title_short | Transition from hypothyroidism to Graves’ disease, development of thyroid eye disease, progression to optic neuropathy after inpatient pulse therapy, and long-term administration of outpatient pulse therapy: a case report with review of literature |
| title_sort | transition from hypothyroidism to graves disease development of thyroid eye disease progression to optic neuropathy after inpatient pulse therapy and long term administration of outpatient pulse therapy a case report with review of literature |
| topic | graves’ disease hashimoto’s thyroiditis dysthyroid optic neuropathy pulse therapy thyroid-stimulating antibody |
| url | https://www.jstage.jst.go.jp/article/endocrj/72/1/72_EJ24-0347/_html/-char/en |
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