{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T13:30:54Z","timestamp":1787059854512,"version":"build-2736575974"},"reference-count":12,"publisher":"Bioscientifica","issue":"2","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":93,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Thyroid eye disease (TED) is the most common extrathyroidal manifestation of Graves\u2019 disease, with an incidence of approximately 1.9 cases per 10,000 inhabitants per year. Its pathophysiology involves an autoimmune response mediated by TSH receptor antibodies (TRAbs), leading to inflammation, fibroblast activation, and orbital tissue remodeling. Although TED typically becomes inactive within 1\u20133 years, 5\u201310% of patients experience recurrences. Persistence or reactivation after total thyroidectomy is uncommon, and published reports remain limited. We report a 56-year-old man with Graves\u2019 disease diagnosed in 2020 and multiple TED reactivations treated with intravenous methylprednisolone. In 2022, he was diagnosed with low-risk papillary thyroid carcinoma (T1a N0 M0) and underwent total thyroidectomy; radioiodine therapy was withheld due to orbitopathy. Despite complete surgery, he developed a new reactivation in November 2023. In March 2025, he presented with ocular pain; active TED was confirmed with a CAS of 6\/7 and moderate-to-severe EUGOGO classification. Laboratory tests revealed positive TRAbs and suppressed TSH. A multidisciplinary team recommended another steroid course followed by tocilizumab. TED reactivation after thyroidectomy is rare and challenges the rationale of antigen removal. Possible mechanisms include microscopic residual thyroid tissue or persistent TRAb activity. Similar reports are limited, and this appears to be the first case described in Colombia. This case highlights the need for multidisciplinary management and the potential role of immunomodulators such as tocilizumab in refractory post-thyroidectomy TED. Further research is needed to clarify factors contributing to disease persistence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1530\/edm-25-0173","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T16:57:37Z","timestamp":1781024257000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["Reactivation after total thyroidectomy? A thyroid eye disease case that challenges established clinical paradigms"],"prefix":"10.1530","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1685-8186","authenticated-orcid":true,"given":"Alejandra","family":"Ni\u00f1o Alarc\u00f3n","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogot\u00e1, Colombia 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana Cristina","family":"Henao","sequence":"additional","affiliation":[{"name":"Endocrinology Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogot\u00e1, Colombia 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Rojas","sequence":"additional","affiliation":[{"name":"Endocrinology Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogot\u00e1, Colombia 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Mar\u00eda","family":"Gomez","sequence":"additional","affiliation":[{"name":"Endocrinology Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogot\u00e1, Colombia 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeimer","family":"Ortiz Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Endocrinology Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogot\u00e1, Colombia 2"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"2026081809165048600_bib1","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.ecl.2021.12.004","article-title":"2022 update on clinical management of Graves disease and thyroid eye disease","volume":"51","author":"Hoang","year":"2022","journal-title":"Endocrinol Metab Clin North 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