{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T11:59:09Z","timestamp":1785153549129,"version":"3.55.0"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Ophthalmol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The aim of this study was to report an atypical presentation of dysthyroid optic neuropathy (DON) characterized by severe bilateral optic disc edema mimicking papilledema.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 71-year-old man with hypothyroidism presented with 6 months of progressive bilateral vision loss and Fris\u00e9n grade 4\u20135 optic disc edema. Comprehensive neuro-ophthalmic evaluation, orbital imaging, and laboratory testing were performed to establish the diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Despite presenting with severe optic disc edema typically associated with papilledema, imaging revealed Type 2 thyroid eye disease with apical muscular crowding exceeding 67% and elevated thyroid-stimulating immunoglobulin. Normal lumbar puncture opening pressure excluded elevated intracranial pressure. Following treatment with high-dose intravenous methylprednisolone and staged bilateral three-wall orbital decompression, visual acuity improved from 20\/30 to 20\/20 bilaterally, with complete resolution of disc edema and visual field defects at 3 months follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Severe optic disc edema is an uncommon but important presenting feature of DON that may mimic papilledema. This case emphasizes the critical importance of considering thyroid eye disease in the differential diagnosis of bilateral optic disc edema, even in the absence of prominent orbital signs, and demonstrates excellent visual outcomes with prompt corticosteroid therapy and surgical decompression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fopht.2026.1870279","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T11:04:30Z","timestamp":1785150270000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Marked bilateral optic disc edema as the presenting manifestation of thyroid eye disease with dysthyroid optic neuropathy"],"prefix":"10.3389","volume":"6","author":[{"given":"Isabella V. Y.","family":"Gomes","sequence":"first","affiliation":[{"name":"Washington University School of Medicine","place":["St. Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Krachmalnick","sequence":"additional","affiliation":[{"name":"John F. Hardesty, MD Department of Ophthalmology & Visual Sciences, Washington University School of Medicine","place":["St. Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Ryu","sequence":"additional","affiliation":[{"name":"John F. Hardesty, MD Department of Ophthalmology & Visual Sciences, Washington University School of Medicine","place":["St. Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leanne","family":"Stunkel","sequence":"additional","affiliation":[{"name":"John F. Hardesty, MD Department of Ophthalmology & Visual Sciences, Washington University School of Medicine","place":["St. Louis, MO, United States"]},{"name":"Department of Neurology, Washington University School of Medicine","place":["St. Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms252111628","article-title":"A comprehensive review of thyroid eye disease pathogenesis: From immune dysregulations to novel diagnostic and therapeutic approaches","volume":"25","author":"Kulbay","year":"2024","journal-title":"Int J Mol Sci"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/249125","article-title":"Graves' ophthalmopathy: VISA versus EUGOGO classification, assessment, and management","volume":"2015","author":"Barrio-Barrio","year":"2015","journal-title":"J Ophthalmol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2006.094607","article-title":"Clinical features of dysthyroid optic neuropathy: a European Group on Graves' Orbitopathy (EUGOGO) survey","volume":"91","author":"McKeag","year":"2007","journal-title":"Br J Ophthalmol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.6061\/clinics\/2012(11)18","article-title":"Imaging studies for diagnosing Graves' orbitopathy and dysthyroid optic neuropathy","author":"Gon\u00e7alves","year":"2012","journal-title":"Clinics (Sao Paulo)"},{"key":"B5","article-title":"Thyroid eye disease","volume-title":"Statpearls","author":"Shah","year":"2025"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1159\/000320438","article-title":"Early versus late orbital decompression in Graves' orbitopathy: a retrospective study in 125 patients","volume":"113","author":"Baldeschi","year":"2006","journal-title":"Ophthalmology"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.4103\/tjo.tjo-d-22-00110","article-title":"Changes in retinal nerve fiber layer, ganglion cell complex, and ganglion cell layer thickness in thyroid eye disease: A systematic review","volume":"14","author":"Chien","year":"2023","journal-title":"Taiwan J Ophthalmol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-96831-9","article-title":"Optical coherence tomography surpasses fundus imaging and intracranial pressure measurement in monitoring idiopathic intracranial hypertension","volume":"15","author":"Huang-Link","year":"2025","journal-title":"Sci Rep"},{"key":"B9","volume-title":"Diseases of the Orbit: A Multidisciplinary Approach","author":"Rootman","year":"2003"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3341\/kjo.2012.26.2.73","article-title":"Clinical profile and visual outcomes after treatment in patients with dysthyroid optic neuropathy","volume":"26","author":"Choi","year":"2012","journal-title":"Korean J Ophthalmol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9394(14)73194-0","article-title":"Results of transantral orbital decompression in 428 patients with severe Graves' ophthalmopathy","volume":"116","author":"Garrity","year":"1993","journal-title":"Am J Ophthalmol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1038\/s41433-023-02856-7","article-title":"Dysthyroid optic neuropathy: a case series at a tertiary ophthalmic referral centre","volume":"38","author":"Chung","year":"2024","journal-title":"Eye (Lond)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"101111","DOI":"10.1016\/j.ajoc.2021.101111","article-title":"Early efficacy of teprotumumab for the treatment of dysthyroid optic neuropathy: a multicenter study","volume":"23","author":"Sears","year":"2021","journal-title":"Am J Ophthalmol Case Rep"},{"key":"B14","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1177\/10507256251372194","article-title":"Teprotumumab treatment in patients with steroid and surgery refractory dysthyroid optic neuropathy","volume":"35","author":"Campi","year":"2025","journal-title":"Thyroid"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1530\/eje-16-0552","article-title":"Management of endocrine disease: Rituximab therapy for Graves' orbitopathy - 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