Active Moderate-to-Severe Thyroid Eye Disease: A Case Series
https://doi.org/10.15605/jafes.041.S1
- Author:
Salmi Fatirah Salim
1
;
Chee Koon Low
1
;
Abdullah Shamshir Abd Mokti
1
;
Akmal Haliza Zamli
2
Author Information
1. Endocrine Unit, Department of Internal Medicine, Hospital Tengku Ampuan Afzan
2. Department of Ophthalmology, Hospital Tengku Ampuan Afzan
- Publication Type:Journal Article
- MeSH:
Graves Ophthalmopathy
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):102-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Thyroid eye disease (TED) is a heterogeneous condition and
the most common extrathyroidal manifestation of Graves’
disease. Although most cases are mild, disease progression
may threaten vision and significantly impact quality of life.
Methodology:We described four patients with active moderate-to-severe
TED, highlighting their clinical characteristics, therapeutic
approaches, and clinical outcomes.
Results:Three males and one female patient were included in this
descriptive study. Most were identified by the endocrine
team. Their median age was 52.5 years (range 47–56 years).
All patients had long-standing Graves’ disease (range 6–10
years). Two of them were active smokers. Their clinical
activity score ranged from 3 to 5. Common presenting
features included diplopia (60%), proptosis (60%), and
ocular redness (60%).
At the onset of active TED, all patients were euthyroid while
receiving either antithyroid therapy or were maintained on
stable levothyroxine following radioactive iodine treatment
and thyroidectomy. Thyroid receptor autoantibodies were
assessed in only two patients, with one elevated result. Orbital
computed tomography, performed in 3 patients, demonstrated extraocular muscle enlargement consistent with
TED, particularly involving the inferior and medial recti. All patients received standard-dose intravenous methylprednisolone (cumulative 3.5–4.5 g). They showed
improvement in visual acuity following treatment, with
partial improvement in ophthalmoplegia.
Conclusion:Clinical risk factors observed in this series were consistent
with the literature. TED diagnosis relies heavily on
recognition by the endocrine team, underscoring the
importance of holistic Graves’ disease management. Highdose corticosteroids remain the mainstay of treatment
in our setting, with generally favorable outcomes when
timely multidisciplinary care is provided.
- Full text:2026080416490884168EP_A148.pdf
