Euthyroid Graves orbitopathy

Euthyroid Graves orbitopathy (also called euthyroid Graves ophthalmopathy or euthyroid thyroid eye disease) is a rare condition where the eyes develop the same swelling and inflammation seen in Graves' disease, but without the thyroid gland being overactive. In typical Graves' disease, the immune system attacks the thyroid gland, causing it to produce too much thyroid hormone, and often also attacks the tissues around the eyes. In euthyroid Graves orbitopathy, the thyroid hormone levels remain normal (euthyroid means normal thyroid function), yet the immune system still targets the muscles and fatty tissue behind the eyes. This leads to eye bulging (proptosis), swelling of the eyelids, double vision, eye pain, redness, and in severe cases, pressure on the optic nerve that can threaten vision. The condition can affect one or both eyes and tends to occur in adults. Because thyroid blood tests come back normal, diagnosis can be delayed or initially missed. Doctors rely on clinical examination, imaging of the eye sockets (usually CT or MRI scans), and blood tests for thyroid antibodies — particularly thyroid-stimulating immunoglobulins (TSI) or TSH receptor antibodies (TRAb) — which may be positive even when thyroid function is normal. Treatment is similar to that used for Graves orbitopathy with thyroid dysfunction and may include lubricating eye drops, corticosteroids to reduce inflammation, orbital radiation therapy, and in some cases surgery to decompress the eye socket. The FDA-approved biologic teprotumumab (Tepezza), which targets the insulin-like growth factor 1 receptor, has been approved for thyroid eye disease and may also be considered. Monitoring by an experienced ophthalmologist is essential to prevent vision loss.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

Bring these to your next appointment

• Q1.Is my disease in the active inflammatory phase or has it stabilized?,Should I be tested for thyroid antibodies even though my thyroid levels are normal?,Am I at risk of developing thyroid problems in the future, and how often should my thyroid be checked?,Is teprotumumab (Tepezza) an appropriate treatment option for me?,What signs should I watch for that would indicate my vision is at risk?,Will I need surgery, and if so, what type and when?,Are there lifestyle changes I can make to help manage or slow the disease?

Common questions about Euthyroid Graves orbitopathy