Purpose

To investigate patients with clinical and radiologic evidence of thyroid eye disease (TED) who lacked thyroid dysfunction and autoantibodies at presentation. This entity should be distinguished from the more prevalent euthyroid TED, characterized by normal thyroid function but positivity for other thyroid-related antibodies.

---

Methods

A retrospective cohort study including all patients evaluated at the multidisciplinary TED clinic between 2008 and 2024. Eighteen patients met criteria for presumed TED—defined by characteristic clinical and radiologic findings of TED with normal thyroid function and negative thyroid autoantibodies at baseline—while 344 had confirmed TED with laboratory or functional thyroid abnormalities. Demographic, clinical, and treatment characteristics were compared between the presumed and confirmed TED groups.

---

Results

Presumed TED accounted for 5% of the cohort. Male sex was more common in presumed TED (61.1% vs. 27.6%, P = 0.0021), and family history of thyroid disease was less frequent (6.3% vs. 29.8%, P = 0.0424). Disease duration at presentation was shorter in presumed TED (8.0 vs. 25.0 weeks, P = 0.0026). Baseline visual acuity, proptosis, diplopia (47.1% vs. 35.3%, P = 0.324), and clinical activity score (median 0 vs. 1, P = 0.544) were comparable between groups. At final follow-up, extraocular motility limitation was more frequent in presumed TED (50.0% vs. 18.6%, P = 0.0156), while diplopia and inflammation remained similar. Systemic corticosteroids were used more often in presumed TED (27.8% vs. 10.5%, P = 0.0239), and orbital steroid injections were administered only in this group (5.6% vs. 0%, P < 0.0001). Four patients from the presumed TED group developed TSI antibodies during follow-up.

---

Conclusion

Approximately 5% of TED patients initially presented without thyroid dysfunction or detectable autoantibodies. Presumed TED showed a marked male predominance and higher corticosteroid use. Some patients developed thyroid autoantibodies during follow-up, suggesting early or evolving autoimmune disease, while others remained persistently seronegative.

---

Additional Authors

First name	Last name	Base Hospital / Institution
David	Carmon	Wolfson Medical Center
Bar	Klain	Tel Aviv University
Elad	Alexander	Tel Aviv University
Havi	Murad	Tel Aviv University
Nancy	Agmon-Levin	Sheba Medical Center
Tali	Cukierman-Yaffe	Sheba Medical Center
Ayelet	Priel	Sheba Medical Center
Ofira	Zloto	Sheba Medical Center
Daphna	Landau-Prat	Sheba Medical Center
Guy	Ben Simon	Sheba Medical Center

↑ Back to top