{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:34:56Z","timestamp":1785436496132,"version":"3.56.0"},"reference-count":17,"publisher":"Bioscientifica","content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2016,6,2]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    TSH receptor antibodies (TRAbs) are the pathological hallmark of Graves\u2019 disease, present in nearly all patients with the disease. Euthyroid Graves\u2019 ophthalmopathy (EGO) is a well-recognized clinical entity, but its occurrence in patients with negative TRAbs is a potential source of diagnostic confusion. A 66-year-old female presented to our endocrinology clinic with right eye pain and diplopia in the absence of thyroid dysfunction. TRAbs were negative, as measured with a highly sensitive third\n                    <jats:sup>-<\/jats:sup>\n                    generation thyrotropin-binding inhibitory immunoglobulin (TBII) ELISA assay. CT and MRI scans of the orbit showed asymmetrical thickening of the inferior rectus muscles but no other inflammatory or malignant orbital pathology. Graves\u2019 ophthalmopathy (GO) was diagnosed on the basis of the clinical and radiological features, and she underwent surgical recession of the inferior rectus muscle with complete resolution of the diplopia and orbital pain. She remained euthyroid over the course of follow-up but ultimately developed overt clinical and biochemical hyperthyroidism, 24 months after the initial presentation. By this time, she had developed positive TRAb as well as thyroid peroxidase antibodies. She responded to treatment with thionamides and remains euthyroid. This case highlights the potential for negative thyroid-specific autoantibodies in the presentation of EGO and underscores the variable temporal relationship between the clinical expression of thyroid dysfunction and orbital disease in the natural evolution of Graves\u2019 disease.\n                  <\/jats:p>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Euthyroid Graves\u2019 ophthalmopathy can present initially with negative thyroid-specific autoantibodies.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Patients with suggestive symptoms of ophthalmopathy should be carefully evaluated for GO with imaging studies even when thyroid function and autoantibodies are normal.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Patients with EGO can develop thyroid dysfunction within 4 years of follow-up underpinning the need for long-term follow-up and continued patient and physician vigilance in patients who have been treated for EGO.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/edm-16-0008","type":"journal-article","created":{"date-parts":[[2016,6,7]],"date-time":"2016-06-07T06:37:31Z","timestamp":1465281451000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":14,"title":["Thyroid antibody-negative euthyroid Graves\u2019 ophthalmopathy"],"prefix":"10.1530","volume":"2016","author":[{"given":"Arshiya","family":"Tabasum","sequence":"first","affiliation":[{"name":"1Department of Diabetes and Endocrinology, Prince Charles Hospital, Cwm Taf Health Board, Merthyr Tydfil, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishrat","family":"Khan","sequence":"additional","affiliation":[{"name":"1Department of Diabetes and Endocrinology, Prince Charles Hospital, Cwm Taf Health Board, Merthyr Tydfil, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Taylor","sequence":"additional","affiliation":[{"name":"1Department of Diabetes and Endocrinology, Prince Charles Hospital, Cwm Taf Health Board, Merthyr Tydfil, UK"},{"name":"2Thyroid Research Group, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gautam","family":"Das","sequence":"additional","affiliation":[{"name":"1Department of Diabetes and Endocrinology, Prince Charles Hospital, Cwm Taf Health Board, Merthyr Tydfil, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Onyebuchi E","family":"Okosieme","sequence":"additional","affiliation":[{"name":"1Department of Diabetes and Endocrinology, Prince Charles Hospital, Cwm Taf Health Board, Merthyr Tydfil, UK"},{"name":"2Thyroid Research Group, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"key20160610151751578_bib1","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1056\/NEJMcp0806317","article-title":"Clinical practice. 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